MARDI I GOMBERG MAITLAND MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****13

License Status

NOT RENEWED

Business

First Name

MARDI

Middle

Last Name

GOMBERG MAITLAND

Suffix

Business Name

MARDI I GOMBERG MAITLAND MD

Original Issue Date

07/09/2003

Effective Date

06/13/2014

Expiration Date

07/31/2017

City

CHICAGO

State

Zip

60637

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017