Provider Demographics
NPI:1093456014
Name:MODY, NIRALI
Entity Type:Individual
Prefix:
First Name:NIRALI
Middle Name:
Last Name:MODY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5426 RANGEMORE DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-3649
Mailing Address - Country:US
Mailing Address - Phone:847-208-4664
Mailing Address - Fax:
Practice Address - Street 1:42141 MOUND RD # B
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-3144
Practice Address - Country:US
Practice Address - Phone:586-254-7593
Practice Address - Fax:586-254-7834
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704330177208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics