Individual
KRISHNA DIPAK MODI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
630 E NORTH AVE, CAROL STREAM, IL 60188-2127
(630) 458-5300
Mailing address
630 E NORTH AVE, CAROL STREAM, IL 60188-2127
(630) 458-5300
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036163060
IL
Other
Enumeration date
04/13/2020
Last updated
09/22/2023
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