Individual
MOHAMAD MIKE MODARESI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LSA
Contact information
Practice address
4815 JESSICA CT, SUGAR LAND, TX 77479-5444
(832) 368-2200
Mailing address
4815 JESSICA CT, SUGAR LAND, TX 77479-5444
(832) 368-2200
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
SA00285
TX
Other
Enumeration date
04/18/2007
Last updated
04/16/2012
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