Individual
PRADEEP MODUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1600 W 38TH ST STE 200, AUSTIN, TX 78731-6405
(512) 324-3540
Mailing address
1600 W 38TH ST STE 200, AUSTIN, TX 78731-6405
Taxonomy
Speciality
Code
Description
License number
State
2084E0001X
Epilepsy Physician
M5841
TX
2084N0400X
Neurology Physician
Primary
M5841
TX
2084N0600X
Clinical Neurophysiology Physician
M5841
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64017767
—
KY
Enumeration date
07/12/2005
Last updated
02/05/2024
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