Provider Demographics
NPI:1366616435
Name:MODI, SNESHA H (MD)
Entity type:Individual
Prefix:DR
First Name:SNESHA
Middle Name:H
Last Name:MODI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SNESHA
Other - Middle Name:HARSHADBHAI
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3868
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47737-3868
Mailing Address - Country:US
Mailing Address - Phone:812-450-6879
Mailing Address - Fax:812-858-4545
Practice Address - Street 1:421 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1227
Practice Address - Country:US
Practice Address - Phone:812-426-9372
Practice Address - Fax:812-858-4545
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 116594207R00000X
WI56246-020207R00000X
IL036.128720207R00000X
IN01076157A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine