LUCY G BASTA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****04

License Status

NOT RENEWED

Business

First Name

LUCY G

Last Name

BASTA

Suffix

Business Name

LUCY G BASTA MD

Original Issue Date

10/30/1981

Effective Date

10/30/1981

Expiration Date

09/01/1982

City

DOWNERS GROVE

State

Zip

60515

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006