Provider Demographics
NPI:1114971850
Name:MODI, DIPABEN D (MD)
Entity Type:Individual
Prefix:
First Name:DIPABEN
Middle Name:D
Last Name:MODI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BAYLOR PLZ
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3411
Mailing Address - Country:US
Mailing Address - Phone:832-744-9390
Mailing Address - Fax:
Practice Address - Street 1:7200 MCNAIR
Practice Address - Street 2:SUITE 8A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-798-2400
Practice Address - Fax:713-798-2688
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1244207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8M5415OtherBCBSTX PROV NO
I31832Medicare UPIN
TX8D5946Medicare PIN
TX8J4302Medicare PIN