MEDICARE: DR. SEEMA C MODI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician	N0285	TX

General Provider Information

NPI Number	:	1043204423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEEMA C MODI MD

Provider Business Mailing Address
First Line	:	4323 N JOSEY LN
Second Line	:	PLAZA 1, SUITE 204
City	:	CARROLLTON
State	:	TX
Zip	:	75010-4619
Country	:	US
Telephone Number	:	972-492-4400
Fax Number	:	972-248-1701

Provider Business Practice Location Address
First Line	:	5941 DALLAS PKWY STE 100
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-9002
Country	:	US
Telephone Number	:	972-758-4455
Fax Number	:	972-758-4433

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	10/18/2024

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