MARJORIE LOU FORMAN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036049042

License Status

NOT RENEWED

Business

First Name

MARJORIE LOU

Last Name

FORMAN

Suffix

Business Name

MARJORIE LOU FORMAN MD

Original Issue Date

03/26/1974

Effective Date

03/26/1974

Expiration Date

07/31/2002

City

CHICAGO

State

Zip

60610

County

COOK

Ever Disciplined

LastModifiedDate

10/09/2006