ERIC MICHAEL MASAC IMOTO DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****26

License Status

NOT RENEWED

Business

Title

First Name

ERIC

Middle

MICHAEL MASAC

Last Name

IMOTO

Business Name

ERIC MICHAEL MASAC IMOTO DO

Original Issue Date

10/15/2012

Effective Date

10/15/2012

Expiration Date

07/31/2014

City

OAK LAWN

State

Zip

60453

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014