Provider Demographics
NPI:1255088720
Name:MODERN MEDICINE PLLC
Entity type:Organization
Organization Name:MODERN MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVANGARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-607-5704
Mailing Address - Street 1:919 REINICKE ST STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-5191
Mailing Address - Country:US
Mailing Address - Phone:346-351-7958
Mailing Address - Fax:803-932-9618
Practice Address - Street 1:919 REINICKE ST STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-5191
Practice Address - Country:US
Practice Address - Phone:346-351-7958
Practice Address - Fax:803-932-9618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-04
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty