STANFORD EDWIN MERMELSTEIN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****30

License Status

NOT RENEWED

Business

First Name

STANFORD EDWIN

Last Name

MERMELSTEIN

Suffix

Business Name

STANFORD EDWIN MERMELSTEIN MD

Original Issue Date

01/01/1997

Expiration Date

09/01/1982

City

CHAMPAIGN

State

Zip

61820

County

CHAMPAIGN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006