Provider Demographics
NPI:1790715761
Name:MODEM, VINAI MODINI (MD)
Entity Type:Individual
Prefix:DR
First Name:VINAI
Middle Name:MODINI
Last Name:MODEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MODINI
Other - Middle Name:
Other - Last Name:VINAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:801 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2733
Practice Address - Country:US
Practice Address - Phone:682-885-7942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM34162080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM3416OtherTEXAS PHYSICIAN PERMIT
TXH74762Medicare UPIN
TX8J1610Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER