RAYMOND MICHAEL DEPA Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****16

License Status

CANCELLED

Business

First Name

RAYMOND

Middle

MICHAEL

Last Name

DEPA

Business Name

RAYMOND MICHAEL DEPA

Original Issue Date

01/11/2002

Effective Date

01/11/2002

Expiration Date

07/31/2005

City

LIBERTYVILLE

State

Zip

60048

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/12/2017