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Individual

DR. BRANCE E MODIN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
512 SKYLINE BLVD, CLOQUET, MN 55720-3787
(218) 879-1271
Mailing address
512 SKYLINE BLVD, CLOQUET, MN 55720-3787
(218) 879-1271

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
30495
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
237082400
MN
Enumeration date
07/22/2006
Last updated
12/02/2020
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