MIRA MODI DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125082677

License Status

CANCELLED

Business

Title

First Name

MIRA

Last Name

MODI

Business Name

MIRA MODI DO

Original Issue Date

07/01/2024

Effective Date

07/01/2024

Expiration Date

06/30/2026

City

CHICAGO

State

Zip

60608

County

COOK

Specialty/Qualifier

Physical Medicine and Rehabilitation

Ever Disciplined

LastModifiedDate

09/25/2025