MARIE-ELLEN TUBAL SARVIDA 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

MARIE-ELLEN

Middle

TUBAL

Last Name

SARVIDA

Suffix

Business Name

MARIE-ELLEN TUBAL SARVIDA MD

Original Issue Date

08/12/2004

Effective Date

08/12/2004

Expiration Date

07/31/2005

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020