# DIXITKUMAR N MODI MD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962059493
- **Authorized official:** DR. DIXITKUMAR NAVINCHANDRA MODI MD (OWNER)
- **Authorized official phone:** (334) 327-9530

## Contact information

- **Practice address:** 4350 N ATLANTIC AVE, COCOA BEACH, FL 32931-3656
- **Practice address phone:** (334) 327-9530
- **Mailing address:** 3003 TRASONA DR, MELBOURNE, FL 32940-7670
- **Mailing address phone:** (321) 613-5352
- **Mailing address fax:** (321) 613-5356

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 08/20/2019
- **Last updated:** 02/23/2024