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General NPI Number Information
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NPI Number | 1922345107
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Entity Type | Organization
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Legal Business Name | PRAVEEN MODI, M.D., P.C.
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Dates
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Enumeration Date | 01/09/2013
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Last Update Date | 01/09/2013
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Provider Practice Location Address
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Address Line | 990 W ANN ARBOR TRL SUITE 102
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City | PLYMOUTH
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State | MI
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Zip | 48170-6204
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Country | US
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Telephone | 734-414-1088
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Fax | 734-414-1095
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Provider Business Mailing Address
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Address Line | 990 W ANN ARBOR TRL
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City | PLYMOUTH
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State | MI
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Zip | 48170-6204
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Country | US
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Telephone | 734-414-1088
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Fax | 734-414-1095
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DONNA BILLAND
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Credential |
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Telephone | 734-414-1023
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | PM069773
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License Number State | MI
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