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Individual

DR. MICHAEL MODICA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
8750 WILSHIRE BLVD STE 100, BEVERLY HILLS, CA 90211-2708
(310) 689-3100
Mailing address
877 W MAIN ST, SUITE 603, BOISE, ID 83702-5883
(208) 367-2161
(208) 367-2989

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
251042
MA
2085R0202X
Diagnostic Radiology Physician
Primary
C193571
CA

Other

Enumeration date
08/07/2007
Last updated
10/23/2024
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