OLIVER MODEQUILLO OLEA Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****53

License Status

NOT RENEWED

Business

First Name

OLIVER

Middle

MODEQUILLO

Last Name

OLEA

Business Name

OLIVER MODEQUILLO OLEA

Original Issue Date

02/09/2006

Effective Date

04/12/2017

Expiration Date

09/30/2020

City

GENEVA

State

Zip

60134

County

DEKALB

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021