Provider Demographics
NPI:1124224415
Name:MODAWI, IMAD SALAH (MD)
Entity Type:Individual
Prefix:DR
First Name:IMAD
Middle Name:SALAH
Last Name:MODAWI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2387 S LINDEN RD
Mailing Address - Street 2:STE. A
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5436
Mailing Address - Country:US
Mailing Address - Phone:810-733-1700
Mailing Address - Fax:
Practice Address - Street 1:2387 S LINDEN RD
Practice Address - Street 2:STE. A
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5436
Practice Address - Country:US
Practice Address - Phone:810-733-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-23
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301087326207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology