MIZUHO STACY MIMOTO MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125061645

License Status

CANCELLED

Business

Title

First Name

MIZUHO

Middle

STACY

Last Name

MIMOTO

Business Name

MIZUHO STACY MIMOTO MD

Original Issue Date

06/24/2012

Effective Date

06/24/2012

Expiration Date

06/23/2015

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

03/24/2014