Search › Illinois › 207N00000X
Mitul Modi, MD
NPI 1649794876 · on the registry since 2017 · sole proprietor
Practice
- Address
- 2160 S 1st Ave
Maywood, IL 60153 - Phone
- (248) 839-7383
- Organisation at this address
- Walgreen Co
Walgreen Co
Rosin Optical Co., Inc.
Proviso Partners For Health
Loyola University Health SystemInferred from a shared address, not stated in the registry. - Clinicians at this address
- 2,186
Additional practice sites
- 800 Spruce St, Philadelphia, PA
Registry record
- Primary taxonomy
- 207N00000X
207N00000X
- Also registered as
- 207ZD0900X
390200000X - Licence states on file
- IL
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2025-01-16
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois