AUGUSTO ALBERTO MIRAVALLE MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****43

License Status

ACTIVE

Business

First Name

AUGUSTO

Middle

ALBERTO

Last Name

MIRAVALLE

Suffix

Business Name

AUGUSTO ALBERTO MIRAVALLE MD

Original Issue Date

07/25/2023

Effective Date

07/25/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/29/2023