Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mitul B. Modi, MD

Individual provider Dermatopathology (Pathology) Physician · NPI 1649794876

Mitul B. Modi, MD is a Pathology in Maywood, Illinois. Qualified in 2012, 14 years ago. Practices with Rush University Medical Group, a 1,499-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
14
Licensed in
IL
In the registry since
2017
Specialties on file
3
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

2160 S 1st Ave
Maywood, IL 60153-3328
Phone: (248) 839-7383
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 800 Spruce St, Philadelphia, PA 19107-6130 — (215) 829-6992

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X · Licence 036164764 (IL)
Dermatopathology (Pathology) Physician Taxonomy 207ZD0900X · Licence 125079219 (IL)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1649794876
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedJuly 31, 2017
Last updated in NPPESJanuary 16, 2025
Certification dateJanuary 16, 2025
Mailing address2160 S 1st Ave, Maywood, IL 60153-3328

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPATHOLOGY
Also practisesDERMATOLOGY
Medical schoolOTHER
Graduated 2012 (14 years in practice)
Group practice Rush University Medical Group — 1499 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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