Provider Demographics
NPI:1609371855
Name:MODI, SUNJAY
Entity Type:Individual
Prefix:
First Name:SUNJAY
Middle Name:
Last Name:MODI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 W 13 MILE RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6711
Mailing Address - Country:US
Mailing Address - Phone:248-549-0777
Mailing Address - Fax:248-549-5888
Practice Address - Street 1:3600 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6711
Practice Address - Country:US
Practice Address - Phone:248-549-0777
Practice Address - Fax:248-549-5888
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301508720207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology