MEDICARE: DR. KIRAN R MODI M.D.

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	207RC0000X	Cardiovascular Disease Physician	036168016	IL
2	207RC0000X	Cardiovascular Disease Physician	52106	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427016724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIRAN R MODI M.D.

Provider Business Mailing Address
First Line	:	500 N WASHINGTON AVE STE 106
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32796-2759
Country	:	US
Telephone Number	:	321-264-9100
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 N WASHINGTON AVE
Second Line	:	SUITE # 106
City	:	TITUSVILLE
State	:	FL
Zip	:	32796-2759
Country	:	US
Telephone Number	:	321-264-9100
Fax Number	:

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	07/02/2024

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