Provider Demographics
NPI:1164503082
Name:MODLO, ERIK JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:JOSEPH
Last Name:MODLO
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 1:225 ELYRIA ST
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:OH
Mailing Address - Zip Code:44254-1031
Mailing Address - Country:US
Mailing Address - Phone:330-948-9939
Mailing Address - Fax:330-948-2263
Practice Address - Street 1:225 ELYRIA ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:OH
Practice Address - Zip Code:44254-1031
Practice Address - Country:US
Practice Address - Phone:330-948-9939
Practice Address - Fax:330-948-2263
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.097905208G00000X, 208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0053753Medicaid
OH1003849910OtherLODI COMMUNITY CARE CENTER TYPE 2 NPI #
OH2396081OtherLODI COMMUNITY HOSPITAL MEDICAID GROUP #
OH3613031OtherLODI COMMUNITY HOSPITAL MEDICARE #
OH1801807870OtherLODI COMMUNITY HOSPITAL TYPE 2 NPI #
OH3613031OtherLODI COMMUNITY HOSPITAL MEDICARE #