Individual
MR. MITESHKUMAR N MODI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2401 W MAIN ST, MARION, IL 62959-1188
(618) 997-5311
Mailing address
9835 GARDEN CT, SCHILLER PARK, IL 60176-2101
(847) 671-0521
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
IL
Other
Enumeration date
03/15/2007
Last updated
07/08/2007
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