Individual
MEET MODI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6644 E BAYWOOD AVE, MESA, AZ 85206-1747
(480) 321-2000
Mailing address
6902 E EDGEMONT AVE, SCOTTSDALE, AZ 85257-1332
(501) 319-5321
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
69512
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/04/2019
Last updated
08/11/2023
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