Individual
MRINALINI MODAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
800 STANTON L YOUNG BLVD # 8425, OKLAHOMA CITY, OK 73104-5018
(405) 271-6173
Mailing address
800 STANTON L YOUNG BLVD # 8425, OKLAHOMA CITY, OK 73104-5018
(405) 271-6173
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
036171041
IL
207RP1001X
Pulmonary Disease Physician
Primary
38134
OK
208M00000X
Hospitalist Physician
62568
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
38134
OK MEDICAL LICENSE
OK
01
—
62568
CT MEDICAL LICENSE
CT
Enumeration date
03/29/2016
Last updated
09/10/2024
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