Modi, Tejal R.

Modi, Tejal R. is an individual health care provider with primary practice located at 2650 Ridge Ave , Evanston IL 60201-1718. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Modi, Tejal R. can be contacted via phone (847) 570-2111.

Contact Information

Primary practice address
2650 Ridge Ave Evanston IL 60201-1718
Phone: (847) 570-2111
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X

Profile Details

NPI number 1639370794
LBN Legal business name Modi, Tejal R.
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date May 29th, 2007
Last updated Jun 13th, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1639370794 NPPES
Illinois Other 085-002793 IL STATE LIC

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