Basic Information
| Provider Information | |||||||||
| NPI: | 1790764314 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MODAWAL | ||||||||
| FirstName: | ARVIND | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2830 VICTORY PKWY STE 120 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452061786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132453052 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7700 UNIVERSITY CT STE 3100 | ||||||||
| Address2: | UNIVERSITY FAMILY PHYSICIANS-UNIVERSITY POINTE | ||||||||
| City: | WEST CHESTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450696545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134758264 | ||||||||
| FaxNumber: | 5134758265 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2006 | ||||||||
| LastUpdateDate: | 12/13/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QG0300X | 35.070118 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine | 207Q00000X | 35.070118 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0274046 | 05 | OH | MEDICAID |