MARK D FORRESTAL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****07

License Status

NOT RENEWED

Business

First Name

MARK D

Last Name

FORRESTAL

Suffix

Business Name

MARK D FORRESTAL MD

Original Issue Date

03/12/1982

Effective Date

07/24/2017

Expiration Date

09/30/2020

City

PALATINE

State

Zip

60067

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021