IDA HEINTZ GRADOLPH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****05

License Status

NOT RENEWED

Business

First Name

IDA HEINTZ

Last Name

GRADOLPH

Suffix

Business Name

IDA HEINTZ GRADOLPH MD

Original Issue Date

02/21/1984

Effective Date

02/21/1984

Expiration Date

07/31/1999

City

CHICAGO

State

Zip

60602

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006