| Kodiak Medical Pa | |
|
10926 David Taylor Dr Ste 120-105 Charlotte NC 28262-1293 | |
| (888) 566-4201 | |
| Not Available |
| Full Name | Kodiak Medical Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 10926 David Taylor Dr Ste 120-105, Charlotte, North Carolina |
| Authorized Official Name and Position | Sachin Surendra Mody (OWNER) |
| Authorized Official Contact | 8558378808 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kodiak Medical Pa 10926 David Taylor Dr Ste 120-105 Charlotte NC 28262-1293 Ph: (888) 566-4201 | Kodiak Medical Pa 10926 David Taylor Dr Ste 120-105 Charlotte NC 28262-1293 Ph: (888) 566-4201 |
| NPI Number | 1134872252 |
|---|---|
| Provider Enumeration Date | 01/28/2022 |
| Last Update Date | 05/20/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134872252 | NPI | - | NPPES |
| 1134872252 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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