KETKI C MODI Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****13

License Status

ACTIVE

Business

First Name

KETKI C

Last Name

MODI

Business Name

KETKI C MODI

Original Issue Date

09/02/1997

Effective Date

05/07/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60625

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/07/2023