GLEN G GLISTA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036045749

License Status

NOT RENEWED

Business

First Name

GLEN G

Last Name

GLISTA

Suffix

Business Name

GLEN G GLISTA MD

Original Issue Date

07/01/1972

Effective Date

05/15/2017

Expiration Date

09/30/2020

City

OAK BROOK

State

Zip

60523

County

DUPAGE

Ever Disciplined

LastModifiedDate

01/14/2021