Provider Demographics
NPI:1841642659
Name:IFTIKHAR, MIAN HARRIS (MD)
Entity type:Individual
Prefix:
First Name:MIAN
Middle Name:HARRIS
Last Name:IFTIKHAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-8082
Mailing Address - Country:US
Mailing Address - Phone:860-679-3958
Mailing Address - Fax:860-679-1307
Practice Address - Street 1:CENTER ON AGING 263 FARMINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-5215
Practice Address - Country:US
Practice Address - Phone:860-679-3958
Practice Address - Fax:860-679-1307
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301110511207R00000X
CT66681207R00000X
CT066681207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine