Individual
IFTIKHAR ALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2705 S RANGE LINE RD STE A, JOPLIN, MO 64804-3283
(417) 553-4252
Mailing address
2705 S RANGE LINE RD STE A, JOPLIN, MO 64804-3283
(417) 553-4252
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2001007751
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100199760A
—
OK
05
—
100413450B
—
KS
05
—
100413450D
—
KS
01
—
170944
ANTHEM
—
05
—
205269418
—
MO
01
—
P00187608
RR MEDICARE
—
01
—
P0116491
RR MEDICARE
—
Enumeration date
06/27/2006
Last updated
08/15/2023
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