MICHAEL JOHNATHAN MODICA MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125052337

License Status

EXPIRED

Business

Title

First Name

MICHAEL

Middle

JOHNATHAN

Last Name

MODICA

Business Name

MICHAEL JOHNATHAN MODICA MD

Original Issue Date

06/25/2007

Effective Date

06/25/2007

Expiration Date

06/24/2008

City

OAK PARK

State

Zip

60302

County

COOK

Specialty/Qualifier

Transitional Year

Ever Disciplined

LastModifiedDate

06/26/2008