AMOD OM SUREKA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****40

License Status

NOT RENEWED

Business

First Name

AMOD

Middle

Last Name

SUREKA

Suffix

Business Name

AMOD OM SUREKA MD

Original Issue Date

08/20/2002

Effective Date

04/29/2014

Expiration Date

07/31/2017

City

PEORIA

State

Zip

61614

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020