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General NPI Number Information
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NPI Number | 1710829775
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Entity Type | Organization
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Legal Business Name | MODARAI, D.O., S.C.
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Dates
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Enumeration Date | 04/08/2026
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Last Update Date | 04/11/2026
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Provider Practice Location Address
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Address Line | 1450 BUSCH PKWY STE 173
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-4541
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Country | US
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Telephone | 708-571-0279
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Fax |
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Provider Business Mailing Address
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Address Line | 169 MADISON AVE STE 78180
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City | NEW YORK
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State | NY
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Zip | 10016-5101
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Country | US
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Telephone | 708-571-0279
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | FARHAD MODARAI
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Credential | DO
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Telephone | 856-524-2707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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