MARDI I GOMBERG MAITLAND MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036109604

License Status

NOT RENEWED

Business

First Name

MARDI

Middle

Last Name

GOMBERG MAITLAND

Suffix

Business Name

MARDI I GOMBERG MAITLAND MD

Original Issue Date

06/30/2003

Effective Date

06/13/2014

Expiration Date

07/31/2017

City

CHICAGO

State

Zip

60611

County

COOK

Ever Disciplined

LastModifiedDate

11/01/2017