Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 61725 | WI |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 61725 | WI |
NPI | 1295092104 |
---|---|
Provider Name | Daniel Scott Modaff |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53792-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2012 |
Last Update Date | 22/03/2021 |