AMI DEEPAK MODI DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****40

License Status

ACTIVE

Business

Title

First Name

AMI

Middle

DEEPAK

Last Name

MODI

Business Name

AMI DEEPAK MODI DO

Original Issue Date

06/18/2020

Effective Date

05/04/2023

Expiration Date

07/31/2026

City

EVANSTON

State

Zip

60201

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/04/2023