BIJAL SHAH MODI Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****06

License Status

NOT RENEWED

Business

First Name

BIJAL

Middle

SHAH

Last Name

MODI

Business Name

BIJAL SHAH MODI

Original Issue Date

08/02/2007

Effective Date

12/14/2007

Expiration Date

03/01/2010

City

PARK RIDGE

State

Zip

60068

County

COOK

Ever Disciplined

LastModifiedDate

12/16/2010