Individual
KETANG MODI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
9620 STIRLING RD UNIT 111, HOLLYWOOD, FL 33024-8081
(754) 201-1027
Mailing address
3420 WASHINGTON LN, HOLLYWOOD, FL 33026-4627
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
25MB07370200
NJ
2085R0202X
Diagnostic Radiology Physician
Primary
OS11848
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8900507
—
NJ
Enumeration date
10/28/2005
Last updated
02/13/2024
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