Provider Demographics
NPI:1770867061
Name:MODY, KARTIK
Entity type:Individual
Prefix:DR
First Name:KARTIK
Middle Name:
Last Name:MODY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NA
Other - Middle Name:
Other - Last Name:NA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1242 E PRESIDIO RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4946
Mailing Address - Country:US
Mailing Address - Phone:848-467-6493
Mailing Address - Fax:
Practice Address - Street 1:300 W CLARENDON AVE STE 375
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3476
Practice Address - Country:US
Practice Address - Phone:602-277-4161
Practice Address - Fax:602-265-2011
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ456732080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine