EKTA MODI PATEL DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125057580

License Status

CANCELLED

Business

Title

First Name

EKTA

Middle

MODI

Last Name

PATEL

Business Name

EKTA MODI PATEL DO

Original Issue Date

06/24/2010

Effective Date

06/24/2010

Expiration Date

06/23/2013

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

05/05/2010