| Elite Sports Medicine Institute, Ltd. | |
|
760 Pasquinelli Dr Suite 304 Westmont IL 60559-5564 | |
| (630) 789-3764 | |
| (630) 794-9998 |
| Full Name | Elite Sports Medicine Institute, Ltd. |
|---|---|
| Speciality | Family Medicine |
| Location | 760 Pasquinelli Dr, Westmont, Illinois |
| Authorized Official Name and Position | Ketan Rajendra Mody (PRESIDENT) |
| Authorized Official Contact | 6307893764 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elite Sports Medicine Institute, Ltd. Po Box 3231 Oak Brook IL 60522-3231 Ph: (630) 789-3764 | Elite Sports Medicine Institute, Ltd. 760 Pasquinelli Dr Suite 304 Westmont IL 60559-5564 Ph: (630) 789-3764 |
| NPI Number | 1467687806 |
|---|---|
| Provider Enumeration Date | 05/28/2009 |
| Last Update Date | 01/13/2015 |
| Medicare PECOS PAC ID | 5597811422 |
|---|---|
| Medicare Enrollment ID | O20090918000049 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467687806 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | 036119306 (Illinois) | Primary |
| Provider Name | Ketan R Mody |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659562585 PECOS PAC ID: 0345336814 Enrollment ID: I20071013000006 |
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