PETRONILO R COSTA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036046108

License Status

NOT RENEWED

Business

Title

First Name

PETRONILO

Middle

Last Name

COSTA

Business Name

PETRONILO R COSTA MD

Original Issue Date

08/17/1972

Effective Date

06/10/2020

Expiration Date

07/31/2023

City

DEERFIELD

State

Zip

60015

County

LAKE

Ever Disciplined

LastModifiedDate

11/30/2023