MOFESOLA MODUPE DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125079133

License Status

EXPIRED

Business

Title

First Name

MOFESOLA

Last Name

MODUPE

Business Name

MOFESOLA MODUPE DO

Original Issue Date

07/13/2021

Effective Date

07/13/2021

Expiration Date

07/12/2024

City

PEORIA

State

Zip

61605

County

PEORIA

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

10/30/2024