Organization
MODERN MEDICINE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIAS HAIKAL MD (PRESIDENT)
(304) 755-0119
Entity
Organization
Contact information
Practice address
4114 1ST AVE, NITRO, WV 25143
(304) 755-0119
(304) 755-0111
Mailing address
4114 1ST AVE, NITRO, WV 25143-1304
(304) 755-0119
(304) 755-0111
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1111
WV
332B00000X
Durable Medical Equipment & Medical Supplies
11111
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0055458000.
—
WV
01
—
6604540001
DME MAC
WV
Enumeration date
05/25/2006
Last updated
04/19/2012
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