Healthcare Provider Details

I. General information

NPI: 1952232175
Provider Name (Legal Business Name): KONRAD MODSCHIEDLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

556 ADAMS ST
TROY OH
45373-1453
US

IV. Provider business mailing address

906 BRIARCLIFF AVE
PIQUA OH
45356-2708
US

V. Phone/Fax

Practice location:
  • Phone: 937-332-3802
  • Fax:
Mailing address:
  • Phone: 937-418-8845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN190380
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: