| Dixitkumar N Modi Md Pa | |
|
4350 N Atlantic Ave Cocoa Beach FL 32931-3656 | |
| (334) 327-9530 | |
| Not Available |
| Full Name | Dixitkumar N Modi Md Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 4350 N Atlantic Ave, Cocoa Beach, Florida |
| Authorized Official Name and Position | Dixitkumar Navinchandra Modi (OWNER) |
| Authorized Official Contact | 3343279530 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dixitkumar N Modi Md Pa 3003 Trasona Dr Melbourne FL 32940-7670 Ph: (321) 613-5352 | Dixitkumar N Modi Md Pa 4350 N Atlantic Ave Cocoa Beach FL 32931-3656 Ph: (334) 327-9530 |
| NPI Number | 1962059493 |
|---|---|
| Provider Enumeration Date | 08/20/2019 |
| Last Update Date | 02/23/2024 |
| Medicare PECOS PAC ID | 5496086241 |
|---|---|
| Medicare Enrollment ID | O20191009003155 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962059493 | NPI | - | NPPES |
| 104790300 | Medicaid | FL | |
| ME133520 | Other | FL | MEDICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| Provider Name | Dixitkumar Modi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124238506 PECOS PAC ID: 9436203387 Enrollment ID: I20171220002904 |
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