Provider Demographics
NPI:1316051741
Name:RIVERSIDE ORTHOPEDICS, LTD
Entity type:Organization
Organization Name:RIVERSIDE ORTHOPEDICS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPEDIC SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:TARIQ
Authorized Official - Middle Name:BIN
Authorized Official - Last Name:IFTIKHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-484-9480
Mailing Address - Street 1:6641 WEST OGDEN AVENUE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3756
Mailing Address - Country:US
Mailing Address - Phone:708-484-9480
Mailing Address - Fax:708-484-9482
Practice Address - Street 1:6641 WEST OGDEN AVENUE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3756
Practice Address - Country:US
Practice Address - Phone:708-484-9480
Practice Address - Fax:708-484-9482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036047917207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3181386OtherAETNA
IL036047917Medicaid
IL006895400OtherFEDERAL BLACK LUNG PROGRA
IL154664OtherUNITEDHEALTHCARE
IL202841400OtherACS/OWCP
IL320541514OtherTRICARE
ILP00064487OtherRAILROAD MEDICARE
IL01633335OtherBCBS
IL2072539OtherCIGNA
ILAS62001780001OtherCIGNA
IL1343149OtherFIRST HEALTH NETWORK
IL202841400OtherACS/OWCP
ILC43546Medicare UPIN
IL202841400OtherACS/OWCP