Individual
DR. SANJIV S MODI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8955 W 400 N, MICHIGAN CITY, IN 46360-9330
(219) 861-5800
(219) 861-5543
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
01093925A
IN
207RH0003X
Hematology & Oncology Physician
036093810
IL
207RH0003X
Hematology & Oncology Physician
78356
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036093810
—
IL
01
—
830007251
MEDICARE RR
IL
01
—
L77781
MEDICARE INDIV ID# FOR GROUP 336140
IL
01
—
L98056
MEDICARE INDIV ID# FOR GROUP 205474
IL
Enumeration date
09/20/2005
Last updated
10/06/2025
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