GLEN G GLISTA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****28

License Status

NOT RENEWED

Business

First Name

GLEN G

Last Name

GLISTA

Suffix

Business Name

GLEN G GLISTA MD

Original Issue Date

01/01/1997

Effective Date

05/26/2014

Expiration Date

07/31/2017

City

OAK BROOK

State

Zip

60523

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020