MITUL BIPINCHANDRA MODI MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125079219

License Status

CANCELLED

Business

Title

First Name

MITUL

Middle

BIPINCHANDRA

Last Name

MODI

Business Name

MITUL BIPINCHANDRA MODI MD

Original Issue Date

07/01/2022

Effective Date

07/01/2022

Expiration Date

06/30/2023

City

MAYWOOD

State

Zip

60153

Specialty/Qualifier

Dermatopathology

Ever Disciplined

LastModifiedDate

03/29/2022