Modad, Musa
Modad, Musa is an individual health care provider with primary practice located at 719 S Main St , Moscow ID 83843-3041. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Modad, Musa can be contacted via phone (208) 883-1152.Contact Information
Primary practice address
719 S Main St
Moscow ID 83843-3041
Phone: (208) 883-1152
Fax: (208) 882-1486
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Emergency Medicine | 207P00000X | 103780 | Missouri |
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 103780 | Missouri |
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | M-12814 | Idaho |
Profile Details
| NPI number | 1902917834 |
|---|---|
| LBN Legal business name | Modad, Musa |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 31st, 2006 |
| Last updated | Jul 21st, 2022 - about 4 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1902917834 | NPPES |
| Missouri | MEDICAID | 206687410 | |
| Missouri | Other | P00430675 | |
| Missouri | Other | 1235680703 | |
| Missouri | MEDICAID | 1902917834 | |
| Missouri | Other | M-12814 |
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