Individual
MITUL B. MODI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(248) 839-7383
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
036164764
IL
207ZD0900X
Dermatopathology (Pathology) Physician
125079219
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/31/2017
Last updated
01/16/2025
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