Organization
ELITE SPORTS MEDICINE INSTITUTE, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KETAN RAJENDRA MODY M.D. (PRESIDENT)
(630) 789-3764
Entity
Organization
Contact information
Practice address
760 PASQUINELLI DR, SUITE 304, WESTMONT, IL 60559-5564
(630) 789-3764
(630) 794-9998
Mailing address
PO BOX 3231, OAK BROOK, IL 60522-3231
(630) 789-3764
(630) 794-9998
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
036119306
IL
Other
Enumeration date
05/28/2009
Last updated
01/13/2015
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