MICHAEL T MODIC MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036110221

License Status

INACTIVE

Business

Title

First Name

MICHAEL

Middle

Last Name

MODIC

Business Name

MICHAEL T MODIC MD

Original Issue Date

10/02/2003

Effective Date

10/02/2003

Expiration Date

07/31/2005

City

SEVILLE VILLAGE

State

Zip

44273

County

OHIO

Ever Disciplined

LastModifiedDate

01/02/2007