Healthcare Provider Details

I. General information

NPI: 1457492076
Provider Name (Legal Business Name): SADAF ALTAF MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WEST AVE S
LA CROSSE WI
54601-8806
US

IV. Provider business mailing address

800 WEST AVE S
LA CROSSE WI
54601-8806
US

V. Phone/Fax

Practice location:
  • Phone: 608-782-9760
  • Fax:
Mailing address:
  • Phone: 608-782-9760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number50473
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number50473
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number60805
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: