MARK THOMAS COLLINS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****09

License Status

NOT RENEWED

Business

First Name

MARK

Middle

THOMAS

Last Name

COLLINS

Suffix

Business Name

MARK THOMAS COLLINS MD

Original Issue Date

06/22/2000

Effective Date

06/22/2000

Expiration Date

07/31/2005

City

MAYWOOD

State

Zip

60153

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006