KRISTIAN R HENRIQUEZ MIRANDONA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****45

License Status

NOT RENEWED

Business

Title

First Name

KRISTIAN

Middle

Last Name

HENRIQUEZ MIRANDONA

Business Name

KRISTIAN R HENRIQUEZ MIRANDONA MD

Original Issue Date

06/21/2016

Effective Date

05/11/2017

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60657

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021