LUCY ELIZABETH MODAHL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036115812

License Status

NOT RENEWED

Business

First Name

LUCY

Middle

ELIZABETH

Last Name

MODAHL

Suffix

Business Name

LUCY ELIZABETH MODAHL MD

Original Issue Date

05/01/2006

Effective Date

06/20/2011

Expiration Date

07/31/2014

City

EDEN PRARIE

State

Zip

55344

County

MINNESOTA

Ever Disciplined

LastModifiedDate

11/17/2014