Jerome Elmer Modlik

Primary specialty

PsychologistTaxonomy code 103T00000X

License

20040316A Issued in IN

Practice address

8102 Clearvista Pkwy
Indianapolis, IN 46256-1661

Phone

(317) 849-8222

NPI assigned

Jul 16, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1216166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216166400000",
    "number": "1174787436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8055 N RICHARDT AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462561619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8102 CLEARVISTA PKWY",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462561661",
            "telephone_number": "317-849-8222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODLIK",
        "first_name": "JEROME",
        "middle_name": "ELMER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-16",
        "last_updated": "2008-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IN",
            "license": "20040316A",
            "primary": true
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "IN",
            "license": "20040316A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ishaan Khelan Modi
• Ravish Modi
• Sujal Hemant Modi, MD
• Stella Chibogu Modirim
• Dianne R Modleski, NP
• Drashty Paresh Mody
• Harold Calvin Moe, L.M.F.T.
• Paul Ryan Moe, M.D.
• Sharon M Moe, M.D.
• Moeez LLC

• Psychologist in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.