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General NPI Number Information
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NPI Number | 1821431859
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Entity Type | Individual
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Provider Name | ALTAMASH TARIQ IFTIKHAR D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/09/2013
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 9697 SAINT CATHERINES DR
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City | KENOSHA
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State | WI
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Zip | 53158-2118
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Country | US
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Telephone | 262-577-8320
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Fax | 262-577-8372
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Provider Business Mailing Address
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Address Line | 6308 8TH AVE STE 105
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City | KENOSHA
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State | WI
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Zip | 53143-5031
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Country | US
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Telephone | 262-577-8320
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Fax | 262-577-8372
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 81755
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS12908
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 81755
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License Number State | WI
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Taxonomy #5
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | OS12908
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License Number State | FL
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