MAURICIO DANIEL CARBALLO MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****27

License Status

NOT RENEWED

Business

Title

First Name

MAURICIO

Middle

DANIEL

Last Name

CARBALLO

Business Name

MAURICIO DANIEL CARBALLO MD

Original Issue Date

06/18/2012

Effective Date

04/18/2014

Expiration Date

07/31/2017

City

CHICAGO

State

Zip

60616

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017