C MARK CAPISTRANO MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036081491

License Status

INACTIVE

Business

Title

First Name

C MARK

Last Name

CAPISTRANO

Business Name

C MARK CAPISTRANO MD

Original Issue Date

09/15/1990

Effective Date

07/17/2017

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60613

County

COOK

Ever Disciplined

LastModifiedDate

06/02/2021

Case Number

2021001844

Action

Refuse To Renew

Discipline Start Date

05/28/2021

Discipline Reason

physician and surgeon license placed in refuse to renew status due to an adverse action taken by the State of Texas in October 2020.