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General NPI Number Information
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NPI Number | 1396736468
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Entity Type | Individual
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Provider Name | KETANG MODI D.O.
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Gender | Male
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Dates
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Enumeration Date | 10/28/2005
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Last Update Date | 02/13/2024
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Provider Practice Location Address
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Address Line | 9620 STIRLING RD UNIT 111
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City | HOLLYWOOD
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State | FL
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Zip | 33024-8081
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Country | US
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Telephone | 754-201-1027
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Fax |
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Provider Business Mailing Address
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Address Line | 3420 WASHINGTON LN
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City | HOLLYWOOD
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State | FL
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Zip | 33026-4627
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Country | US
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Telephone |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 25MB07370200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | OS11848
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License Number State | FL
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