Provider Demographics
NPI:1164782991
Name:MODI, YASHPAL BHANUPRASAD (MD)
Entity Type:Individual
Prefix:
First Name:YASHPAL
Middle Name:BHANUPRASAD
Last Name:MODI
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:310 N L ROGERS WELLS BLVD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-1300
Mailing Address - Country:US
Mailing Address - Phone:270-659-5890
Mailing Address - Fax:270-659-5698
Practice Address - Street 1:310 N L ROGERS WELLS BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-1300
Practice Address - Country:US
Practice Address - Phone:270-659-5890
Practice Address - Fax:270-659-5698
Is Sole Proprietor?:No
Enumeration Date:2012-05-27
Last Update Date:2023-03-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY47271207R00000X, 207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100311690Medicaid
KYK149622Medicare PIN