Provider Demographics
NPI:1861400749
Name:IFTIKHAR, REHAN (MD)
Entity type:Individual
Prefix:
First Name:REHAN
Middle Name:
Last Name:IFTIKHAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 W GRANT RD STE 160
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-1173
Mailing Address - Country:US
Mailing Address - Phone:520-624-4342
Mailing Address - Fax:520-624-4337
Practice Address - Street 1:1951 W GRANT RD STE 160
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-1173
Practice Address - Country:US
Practice Address - Phone:520-624-4342
Practice Address - Fax:520-624-4337
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001006975207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ347206Medicaid
AZ347206Medicaid
AZZ123343Medicare PIN