PHORNPHAT RASAMIMARI 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

PHORNPHAT

Last Name

RASAMIMARI

Business Name

PHORNPHAT RASAMIMARI

Original Issue Date

09/24/1998

Effective Date

09/24/1998

Expiration Date

07/31/2005

City

CHICAGO

State

Zip

60640

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020