1417946724 NPI number — DR. USHA R MODI MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417946724 NPI number — DR. USHA R MODI MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

MODI

Provider First Name:

USHA

Provider Middle Name:

R

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1417946724

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/08/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

401 S BALLENGER HWY

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

FLINT

Provider Business Mailing Address State Name:

MI

Provider Business Mailing Address Postal Code:

48532-3638

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

810-342-1000

Provider Business Mailing Address Fax Number:

810-342-1590

Provider First Line Business Practice Location Address:

1314 S LINDEN RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

FLINT

Provider Business Practice Location Address State Name:

MI

Provider Business Practice Location Address Postal Code:

48532-3456

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

810-342-1700

Provider Business Practice Location Address Fax Number:

810-720-4035

Provider Enumeration Date:

10/19/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  4301047338 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 4453517 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 1112517472 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 1117472 . This is a "HEALTH PLUS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 204386 . This is a "HEALTH ADVANTAGE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: C2918 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 3814414003 . This is a "CIGNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 204386 . This is a "MCLAREN HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: B49123 . This is a "HEALTH NET FEDERAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 4385880 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
• Identifier: B49123 . This is a "HEALTH ALLIANCE PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 110027153/CD3613 . This is a "METRAHEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".