MIA FLOR MARTIN MICHELENA DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****28

License Status

ACTIVE

Business

Title

First Name

MIA FLOR

Middle

MARTIN

Last Name

MICHELENA

Business Name

MIA FLOR MARTIN MICHELENA DO

Original Issue Date

05/24/2019

Effective Date

05/24/2023

Expiration Date

07/31/2026

City

PARK RIDGE

State

Zip

60068

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/24/2023