CARLA F ORTIQUE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036076382

License Status

NOT RENEWED

Business

First Name

CARLA F

Last Name

ORTIQUE

Suffix

Business Name

CARLA F ORTIQUE MD

Original Issue Date

11/26/1987

Effective Date

11/26/1987

Expiration Date

07/31/1993

City

ROCKFORD

State

Zip

61102

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

09/20/2006