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Dixitkumar N Modi Md Pa

NPI Registration Record

Provider / OrganizationNPIDate Certified
DIXITKUMAR N MODI MD PA19620594932020-10-11
Entity TypeOrganization
Provider OrganizationDIXITKUMAR N MODI MD PA
Practice Office Address4350 N ATLANTIC AVE
COCOA BEACH, FL US
Practice Office Telephone3343279530
Mailing Address3003 TRASONA DR
MELBOURNE, FL 329407670 US
Business Telephone3216135352
Business Fax3216135356
Authorized OfficialDIXITKUMAR NAVINCHANDRA MODI, OWNER
3343279530
HPT Codes
CodeLicense NoState
261QP2300X
207Q00000X PRIMARY
193400000X SINGGroup Code
OPI Codes
104790300 MEDICAID FL
ME133520 OTHER FL MEDICAL LICENSE
Governmental Registrations [CAGE/NCAGE/DUNS]

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