DHRUVANGKUMAR A MODI MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125056098

License Status

CANCELLED

Business

Title

First Name

DHRUVANGKUMAR

Middle

Last Name

MODI

Business Name

DHRUVANGKUMAR A MODI MD

Original Issue Date

07/01/2009

Effective Date

07/01/2009

Expiration Date

06/30/2012

City

PEORIA

State

Zip

61605

County

PEORIA

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

05/18/2009