Healthcare Provider Details

I. General information

NPI: 1942470414
Provider Name (Legal Business Name): FALGUN M. MODHIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 S FREMONT AVE STE 1000
SPRINGFIELD MO
65804
US

IV. Provider business mailing address

2055 S FREMONT AVE STE 1000
SPRINGFIELD MO
65804-2206
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-8099
  • Fax:
Mailing address:
  • Phone: 417-820-8099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2019011177
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number29790
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: