MARY P DEA DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125030067

License Status

EXPIRED

Business

First Name

MARY P

Last Name

DEA

Suffix

Business Name

MARY P DEA DO

Original Issue Date

06/02/1993

Effective Date

06/02/1993

Expiration Date

06/20/1997

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006