Provider Demographics
NPI:1467990838
Name:INNOVATIVE CARE PARTNERS PLLC
Entity Type:Organization
Organization Name:INNOVATIVE CARE PARTNERS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARVIND
Authorized Official - Middle Name:G
Authorized Official - Last Name:MODAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-244-0869
Mailing Address - Street 1:5914 OSO PKWY
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-6037
Mailing Address - Country:US
Mailing Address - Phone:361-244-0869
Mailing Address - Fax:
Practice Address - Street 1:345 S WATER ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78401-2819
Practice Address - Country:US
Practice Address - Phone:361-443-9013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1397207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty