Provider Demographics
NPI:1679375687
Name:IFTIKAR, ILHAM SADIK (MD)
Entity type:Individual
Prefix:
First Name:ILHAM
Middle Name:SADIK
Last Name:IFTIKAR
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 SAN SIMEON CIR
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-6235
Mailing Address - Country:US
Mailing Address - Phone:657-789-3503
Mailing Address - Fax:
Practice Address - Street 1:300 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-4719
Practice Address - Country:US
Practice Address - Phone:662-725-1384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program