1184606022 NPI number — DR. SHAUKAT IFTIKHAR M.D.

Table of content: DR. SHAUKAT IFTIKHAR M.D. (NPI 1184606022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184606022 NPI number — DR. SHAUKAT IFTIKHAR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IFTIKHAR
Provider First Name:
SHAUKAT
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184606022
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1510
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47706-1510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-450-6815
Provider Business Mailing Address Fax Number:
812-858-4512

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
421 CHESTNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVANSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47713-1227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-426-9454
Provider Business Practice Location Address Fax Number:
812-858-4512
Provider Enumeration Date:
11/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  200000468 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: 01071136A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7100283850 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20128480 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0191F . This is a "NCBC GROUP" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 214262 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: PC1896 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 137WO . This is a "BCBS NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89137W0 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00442382 . This is a "RR MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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