SIMON ST JOHN PRENDIVILLE MD 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

SIMON

Middle

ST JOHN

Last Name

PRENDIVILLE

Suffix

Business Name

SIMON ST JOHN PRENDIVILLE MD

Original Issue Date

05/09/2000

Effective Date

05/09/2000

Expiration Date

07/31/2002

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006