MARIA REPUBLICA BALLEZA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****29

License Status

NOT RENEWED

Business

First Name

MARIA REPUBLICA

Last Name

BALLEZA

Suffix

Business Name

MARIA REPUBLICA BALLEZA MD

Original Issue Date

01/06/1983

Effective Date

01/06/1983

Expiration Date

07/31/1993

City

CHICAGO

State

Zip

60618

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006