AVIVA MICHELLE GOLDBERG MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****06

License Status

CANCELLED

Business

First Name

AVIVA

Middle

MICHELLE

Last Name

GOLDBERG

Suffix

Business Name

AVIVA MICHELLE GOLDBERG MD

Original Issue Date

12/28/2004

Effective Date

12/28/2004

Expiration Date

07/31/2008

City

CHICAGO

State

Zip

60614

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/17/2008