LARISA ANN BROGLIE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****44

License Status

NOT RENEWED

Business

Title

First Name

LARISA

Middle

ANN

Last Name

BROGLIE

Business Name

LARISA ANN BROGLIE MD

Original Issue Date

05/01/2013

Effective Date

05/20/2014

Expiration Date

07/31/2017

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017