Provider Demographics
NPI:1255540514
Name:MODI, ACHAL PANKAJ (MD)
Entity type:Individual
Prefix:DR
First Name:ACHAL
Middle Name:PANKAJ
Last Name:MODI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 E HIGHWAY 287
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-5576
Mailing Address - Country:US
Mailing Address - Phone:972-938-8526
Mailing Address - Fax:972-709-5920
Practice Address - Street 1:4440 E HIGHWAY 287
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-5576
Practice Address - Country:US
Practice Address - Phone:972-938-8526
Practice Address - Fax:972-709-5920
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57012170208800000X
TXN9270208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX282992103Medicaid
TX282992105Medicaid
TX282992104OtherMEDICAID OTHER
TXTXB131366Medicare PIN
TXTXB131367Medicare PIN