MICHAEL JOHNATHAN MODICA MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036167651

License Status

ACTIVE

Business

Title

First Name

MICHAEL

Middle

JOHNATHAN

Last Name

MODICA

Business Name

MICHAEL JOHNATHAN MODICA MD

Original Issue Date

11/13/2023

Effective Date

11/13/2023

Expiration Date

07/31/2026

City

BOISE

State

Zip

83702

Ever Disciplined

LastModifiedDate

11/13/2023