Organization
KODIAK MEDICAL PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SACHIN SURENDRA MODY MD (OWNER)
(855) 837-8808
Entity
Organization
Contact information
Practice address
10926 DAVID TAYLOR DR STE 120-105, CHARLOTTE, NC 28262-1293
(888) 566-4201
Mailing address
10926 DAVID TAYLOR DR STE 120-105, CHARLOTTE, NC 28262-1293
(888) 566-4201
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134872252
—
NC
Enumeration date
01/28/2022
Last updated
05/20/2022
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