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General NPI Number Information
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NPI Number | 1003012477
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Entity Type | Individual
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Provider Name | ARIEL MARCELO MODRYKAMIEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2007
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Last Update Date | 04/06/2022
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Provider Practice Location Address
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Address Line | 3600 GASTON AVE WADLEY TOWER, SUITE 960
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City | DALLAS
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State | TX
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Zip | 75246-1800
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Country | US
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Telephone | 402-972-6078
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Fax |
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Provider Business Mailing Address
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Address Line | 3600 GASTON AVE WADLEY TOWER, SUITE 960
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City | DALLAS
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State | TX
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Zip | 75246-1800
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Country | US
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Telephone | 402-972-6078
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | P8278
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | P8278
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License Number State | TX
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