AGNES KATHERINE COSTELLO MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125048733

License Status

EXPIRED

Business

Title

First Name

AGNES

Middle

KATHERINE

Last Name

COSTELLO

Business Name

AGNES KATHERINE COSTELLO MD

Original Issue Date

07/15/2004

Effective Date

07/15/2004

Expiration Date

07/14/2007

City

MAYWOOD

State

Zip

60153

County

COOK

Specialty/Qualifier

Psychiatry

Ever Disciplined

LastModifiedDate

07/25/2007