Basic Information
| Provider Information | |||||||||
| NPI: | 1902029671 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MODELL | ||||||||
| FirstName: | CURT | ||||||||
| MiddleName: | WILLIAM | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14385 CORMORANT WAY | ||||||||
| Address2: | |||||||||
| City: | ROSEMOUNT | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550687113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6514234662 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1440 DUCKWOOD DR | ||||||||
| Address2: | |||||||||
| City: | EAGAN | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551221451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516887857 | ||||||||
| FaxNumber: | 6516887855 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2007 | ||||||||
| LastUpdateDate: | 08/01/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | 1635 | MN | Y | Technologists, Technicians & Other Technical Service Providers | Technician, Other |
No ID Information.