MARY CUSICK COLLINS Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****48

License Status

NOT RENEWED

Business

First Name

MARY

Middle

CUSICK

Last Name

COLLINS

Business Name

MARY CUSICK COLLINS

Original Issue Date

01/01/1997

Effective Date

05/01/2017

Expiration Date

09/30/2020

City

HINES

State

Zip

60141

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021