CLEOFE MARIE SUMAWANG VERGARA Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****05

License Status

CANCELLED

Business

First Name

CLEOFE MARIE

Middle

SUMAWANG

Last Name

VERGARA

Business Name

CLEOFE MARIE SUMAWANG VERGARA

Original Issue Date

04/12/1999

Effective Date

04/12/1999

Expiration Date

07/31/2002

City

CHICAGO

State

Zip

60616

County

COOK

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

09/26/2006