MADALANE G BOLTZ Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****46

License Status

NOT RENEWED

Business

First Name

MADALANE G

Last Name

BOLTZ

Business Name

MADALANE G BOLTZ

Original Issue Date

01/29/1996

Effective Date

01/29/1996

Expiration Date

07/31/1996

City

MAYWOOD

State

Zip

60153

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006