MIZUHO STACY MIMOTO MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036137838

License Status

NOT RENEWED

Business

Title

First Name

MIZUHO

Middle

STACY

Last Name

MIMOTO

Business Name

MIZUHO STACY MIMOTO MD

Original Issue Date

04/22/2015

Effective Date

05/01/2017

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60637

County

COOK

Ever Disciplined

LastModifiedDate

01/14/2021