Healthcare Provider Details

I. General information

NPI: 1790764314
Provider Name (Legal Business Name): ARVIND MODAWAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 12/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 UNIVERSITY CT STE 3100 UNIVERSITY FAMILY PHYSICIANS-UNIVERSITY POINTE
WEST CHESTER OH
45069-6545
US

IV. Provider business mailing address

2830 VICTORY PKWY STE 120
CINCINNATI OH
45206-1786
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-8264
  • Fax: 513-475-8265
Mailing address:
  • Phone: 513-245-3052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number35.070118
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.070118
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: