Individual
CHARLES S MODLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5165 MCCARTY LN, LAFAYETTE, IN 47905-8764
(765) 448-8000
(765) 448-7619
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
01067902A
IN
208800000X
Urology Physician
35064578M
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0232500
—
OH
05
—
300061295
—
IN
01
—
815500567
MEDICARE PTAN
IN
Enumeration date
04/13/2006
Last updated
09/01/2023
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