| Praveen Modi, MD, PC | |
|
3200 Pine Lake Rd West Bloomfield MI 48324-1951 | |
| (248) 830-6697 | |
| (248) 676-0814 |
| Full Name | Praveen Modi, MD, PC |
|---|---|
| Speciality | Internal Medicine |
| Location | 3200 Pine Lake Rd, West Bloomfield, Michigan |
| Authorized Official Name and Position | Praveen Modi (OWNER) |
| Authorized Official Contact | 2488306697 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Praveen Modi, MD, PC 43181 Sandstone Dr Novi MI 48377-2718 Ph: (248) 830-6697 | Praveen Modi, MD, PC 3200 Pine Lake Rd West Bloomfield MI 48324-1951 Ph: (248) 830-6697 |
| NPI Number | 1255528527 |
|---|---|
| Provider Enumeration Date | 10/01/2007 |
| Last Update Date | 06/18/2019 |
| Medicare PECOS PAC ID | 2668447665 |
|---|---|
| Medicare Enrollment ID | O20040901001073 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255528527 | NPI | - | NPPES |
| 4620532 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (NU) | Primary |
| Provider Name | Praveen K Modi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144285669 PECOS PAC ID: 3577450592 Enrollment ID: I20040901001377 |
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