SANJIV S MODI Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****60

License Status

ACTIVE

Business

First Name

SANJIV S

Last Name

MODI

Business Name

SANJIV S MODI

Original Issue Date

03/23/2023

Effective Date

04/07/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60605

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2023