Provider Demographics
NPI:1821431859
Name:IFTIKHAR, ALTAMASH TARIQ (DO)
Entity type:Individual
Prefix:DR
First Name:ALTAMASH
Middle Name:TARIQ
Last Name:IFTIKHAR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6308 8TH AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-5031
Mailing Address - Country:US
Mailing Address - Phone:262-577-8320
Mailing Address - Fax:262-577-8372
Practice Address - Street 1:9697 SAINT CATHERINES DR
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53158-2118
Practice Address - Country:US
Practice Address - Phone:262-577-8320
Practice Address - Fax:262-577-8372
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI81755207Q00000X, 207QS0010X
FLOS12908207Q00000X, 207QS0010X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program