Provider Demographics
NPI:1215975255
Name:MODAK, ARVIND GOPAL (MD)
Entity type:Individual
Prefix:DR
First Name:ARVIND
Middle Name:GOPAL
Last Name:MODAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6994
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-6994
Mailing Address - Country:US
Mailing Address - Phone:361-866-5505
Mailing Address - Fax:361-866-5572
Practice Address - Street 1:5536 SARATOGA BLVD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-2944
Practice Address - Country:US
Practice Address - Phone:361-866-5505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1397207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH08936Medicare UPIN