AMY PHYLLIS GOLDBERG MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****50

License Status

CANCELLED

Business

First Name

AMY

Middle

PHYLLIS

Last Name

GOLDBERG

Suffix

Business Name

AMY PHYLLIS GOLDBERG MD

Original Issue Date

09/14/2000

Effective Date

09/14/2000

Expiration Date

07/31/2002

City

CHICAGO

State

Zip

60614

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006