MAURICIO DANIEL CARBALLO MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036130155

License Status

NOT RENEWED

Business

Title

First Name

MAURICIO

Middle

DANIEL

Last Name

CARBALLO

Business Name

MAURICIO DANIEL CARBALLO MD

Original Issue Date

04/19/2012

Effective Date

04/18/2014

Expiration Date

07/31/2017

City

CHICAGO

State

Zip

60616

County

COOK

Ever Disciplined

LastModifiedDate

11/01/2017