License Verification

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MODINAT YETUNDE BALOGUN

License Number: OS11666

Data As Of 12/2/2024

Profession
Osteopathic Physician
License
OS11666
License Status
CLEAR/Active
Qualifications
Dispensing Practitioner
License Expiration Date
3/31/2026
License Original Issue Date
04/06/2012
Address of Record
2020 N Bayshore Dr.
# 2205
MIAMI, FL 33137
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No

No secondary locations found.


Name Relationship Profession License Effective Date
BORUNDA, MICHAEL ANTHONY Supervising Prescribing Practitioner Medical Doctor 100116 11/15/2024
VIVIANO, ROBERT ANTHONY Supervising Prescribing Practitioner Osteopathic Physician 14359 07/01/2021

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Name Relationship Profession License Effective Date
ALEXANDER, ANDREW JAY SUPER-DOsubordinate Medical Doctor 76090 1/15/2016
COSLOW, MARK NEIDHAMMER Prescribing Physician Assistant Physician Assistant 9104137 9/6/2017
KATANICS, JANOS SUPER-DOsubordinate Medical Doctor 84916 3/17/2016
KIRKLAND, ANDREW Prescribing Physician Assistant Physician Assistant 9111019 3/27/2018
LOPEZ CORTES, MAYLIN YELIKSA SUPER-DOsubordinate Medical Doctor 117226 10/1/2016

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Name Relationship Profession License Effective Date

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No Continuing Education Hours Received from Approved Providers As Of 12/2/2024



* To find out more about Approved Providers, or ask a provider why the course you took is not yet listed, please visit our Continuing Education Providers page.


** Personal Development is limited to no more than 3 hours per renewal cycle. Any personal development hours in excess of this 3 hour maximum cannot be used for renewal and have been subtracted from the total available for renewal.


Please do not fax proof of Continuing Education hours to the Board Office until you have received your renewal notice in the mail.


For instructions on how to request a license certification of your Florida license to be sent to another state from the Florida Department of Health, please visit the License Certifications web page.