MARY COLLEEN COSTELLO MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125048734

License Status

CANCELLED

Business

First Name

MARY

Middle

COLLEEN

Last Name

COSTELLO

Suffix

Business Name

MARY COLLEEN COSTELLO MD

Original Issue Date

07/15/2004

Effective Date

07/15/2004

Expiration Date

07/14/2007

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

09/22/2006