Provider Demographics
NPI:1417946724
Name:MODI, USHA R (MD)
Entity Type:Individual
Prefix:DR
First Name:USHA
Middle Name:R
Last Name:MODI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-1000
Mailing Address - Fax:810-342-1590
Practice Address - Street 1:1314 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3456
Practice Address - Country:US
Practice Address - Phone:810-342-1700
Practice Address - Fax:810-720-4035
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301047338207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4453517OtherAETNA
MI1112517472OtherBLUE CROSS BLUE SHIELD
MI1117472OtherHEALTH PLUS
MI204386OtherHEALTH ADVANTAGE NETWORK
MIC2918OtherMCARE
MI3814414003OtherCIGNA
MA204386OtherMCLAREN HEALTH PLAN
MIB49123OtherHEALTH NET FEDERAL
MI4385880Medicaid
MIB49123OtherHEALTH ALLIANCE PLAN
MI110027153/CD3613OtherMETRAHEALTH
MA204386OtherMCLAREN HEALTH PLAN
MIB49123OtherHEALTH ALLIANCE PLAN