Modic, Mark L

Modic, Mark L is an individual health care provider with primary practice located at 7255 Old Oak Blvd Suite C412, Middleburg Heights OH 44130-3329. He recently has only one registered license in Allopathic & Osteopathic Physicians / Gastroenterology, which is considered as his primary health care specialty. Modic, Mark L can be contacted via phone (440) 816-4546.

Contact Information

Primary practice address
7255 Old Oak Blvd Suite C412 Middleburg Heights OH 44130-3329
Phone: (440) 816-4546
Fax: (440) 816-4549
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Gastroenterology 207RG0100X 049287 Ohio

Profile Details

NPI number 1336148022
LBN Legal business name Modic, Mark L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 15th, 2005
Last updated Oct 4th, 2012 - about 12 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 1336148022 NPPES
Ohio MEDICAID 0660931

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