Healthcare Provider Details

I. General information

NPI: 1508859695
Provider Name (Legal Business Name): WEST PALM BEACH RESOURCES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 11/28/2025
Certification Date: 11/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 SW 57TH AVE STE A
SOUTH MIAMI FL
33143-5330
US

IV. Provider business mailing address

10320 GUATEMALA ST
HOLLYWOOD FL
33026-4600
US

V. Phone/Fax

Practice location:
  • Phone: 833-674-3668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KETANG MODI
Title or Position: PRESIDENT
Credential: DO
Phone: 201-310-2957