MARA DIVIS DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****10

License Status

ACTIVE

Business

Title

First Name

MARA

Last Name

DIVIS

Business Name

MARA DIVIS DO

Original Issue Date

01/05/2012

Effective Date

04/28/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60625

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/28/2023