Individual
IFTIKHAR A SANDHU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2212 N BROADWAY ST, MOORE, OK 73160-4303
(405) 285-7222
(405) 285-7227
Mailing address
2212 N BROADWAY ST, MOORE, OK 73160-4303
(405) 285-7222
(405) 285-7227
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1021
OK
363AM0700X
Medical Physician Assistant
1021
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100224630A
—
OK
01
—
12163067
CAQH
—
Enumeration date
06/23/2006
Last updated
12/05/2025
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