KODIAK MEDICAL PA NPI 1134872252

NPI Information

  • NPI: 1134872252
  • Provider Name: KODIAK MEDICAL PA
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • Address: 10926 DAVID TAYLOR DR STE 120-105
    CHARLOTTE, NC
    ZIP 28262
  • Phone: (888) 566-4201

Map and Directions

Get Directions

NPI Details

KODIAK MEDICAL PA is a family medicine in Charlotte, NC. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. KODIAK MEDICAL PA NPI is 1134872252. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

10926 DAVID TAYLOR DR STE 120-105
CHARLOTTE, NC
ZIP 28262-293
Phone: (888) 566-4201

The provider's authorized official is Sachin Surendra Mody .
The authorized official title is Owner and has the following contact phone number (855) 837-8808.

The enumeration date for this NPI number is 1/28/2022 and was last updated on 5/20/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11134872252MEDICAIDNORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

Previous NPI
Next NPI