| NPI | 1467687806 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KETAN RAJENDRA MODY President 630-789-3764 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036119306) |
| Enumeration Date | 2009-05-28 |
| Last Update Date | 2015-01-13 |