STEFANIE MARTIN DIAZ 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

First Name

STEFANIE

Middle

MARTIN

Last Name

DIAZ

Suffix

Business Name

STEFANIE MARTIN DIAZ MD

Original Issue Date

12/16/1996

Effective Date

12/16/1996

Expiration Date

07/31/1999

City

CHICAGO

State

Zip

60608

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006