Individual
MODNATH SANGROULA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
955 HIGH ST STE 1, DECATUR, IN 46733-2361
(260) 724-8551
(260) 728-3858
Mailing address
955 HIGH ST STE 1, DECATUR, IN 46733-2361
(260) 724-8551
(260) 728-3858
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01089130A
IN
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
10/19/2020
Last updated
09/08/2023
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