Individual
PREETI MODI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3231 S NATIONAL AVE, STE 300, SPRINGFIELD, MO 65807-7304
(417) 888-5658
(417) 841-0104
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036119407
IL
207R00000X
Internal Medicine Physician
Primary
2009003444
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1922261114
—
MO
01
—
431560263
TRICARE
MO
01
—
P00760857
RR MCR
MO
Enumeration date
07/08/2008
Last updated
02/06/2013
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