Individual
MR. MICHAEL JOHN MODROW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3000 NEW BERN AVE, RALEIGH, NC 27610-1231
(919) 350-7601
Mailing address
2920 HIGHWOODS BLVD, RALEIGH, NC 27604-0010
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1032066
NC
363AS0400X
Surgical Physician Assistant
Primary
102199
NC
Other
Enumeration date
05/31/2008
Last updated
03/09/2021
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