Healthcare Provider Details

I. General information

NPI: 1508896671
Provider Name (Legal Business Name): IFTEKHAR BADER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3803 SPRING ST STE 600
RACINE WI
53405-1660
US

IV. Provider business mailing address

3803 SPRING ST STE 600
RACINE WI
53405-1660
US

V. Phone/Fax

Practice location:
  • Phone: 262-687-8312
  • Fax: 262-687-8318
Mailing address:
  • Phone: 262-687-8312
  • Fax: 262-687-8318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number32076
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number32076
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: