Individual
RAHEEL MODY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
205 VALLEY AVE, WEST BEND, WI 53095
(262) 338-1123
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
66960
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100067921
—
WI
Enumeration date
03/24/2015
Last updated
07/18/2024
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