Individual
DR. KETAN R MODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
760 PASQUINELLI DR STE 304, WESTMONT, IL 60559-1290
(630) 789-3764
(630) 206-2490
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
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IL2367001
MEDICARE INDIVIDUAL PTAN
IL
Enumeration date
08/06/2007
Last updated
06/17/2019
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