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NPI Code Detail

MEDICARE: RAJIV MODAK MD

MEDICARE: RAJIV MODAK MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician28426AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1124002324
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAJIV MODAK MD
Provider Business Mailing Address
First Line : 839 W CONGRESS ST
Second Line :
City : TUCSON
State : AZ
Zip : 85745-2819
Country : US
Telephone Number : 520-670-3909
Fax Number : 520-309-2560
Provider Business Practice Location Address
First Line : 1500 W COMMERCE CT
Second Line :
City : TUCSON
State : AZ
Zip : 85746-6031
Country : US
Telephone Number : 520-670-3909
Fax Number : 520-309-2560
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2005
Last Update Date : 01/24/2025

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Directions to “ RAJIV MODAK MD” Practice Location

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