# ELITE SPORTS MEDICINE INSTITUTE, LTD.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467687806
- **Authorized official:** KETAN RAJENDRA MODY M.D. (PRESIDENT)
- **Authorized official phone:** (630) 789-3764

## Contact information

- **Practice address:** 760 PASQUINELLI DR, SUITE 304, WESTMONT, IL 60559-5564
- **Practice address phone:** (630) 789-3764
- **Practice address fax:** (630) 794-9998
- **Mailing address:** PO BOX 3231, OAK BROOK, IL 60522-3231
- **Mailing address phone:** (630) 789-3764
- **Mailing address fax:** (630) 794-9998

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | 036119306 | IL | Yes |

## Other

- **Enumeration date:** 05/28/2009
- **Last updated:** 01/13/2015