MAURICIO DANIEL CARBALLO MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125055640

License Status

CANCELLED

Business

Title

First Name

MAURICIO

Middle

DANIEL

Last Name

CARBALLO

Business Name

MAURICIO DANIEL CARBALLO MD

Original Issue Date

07/01/2009

Effective Date

07/01/2009

Expiration Date

06/30/2012

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

02/26/2009