ANN DECLUE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****50

License Status

NOT RENEWED

Business

Title

First Name

ANN

Last Name

DECLUE

Business Name

ANN DECLUE MD

Original Issue Date

10/23/1986

Effective Date

10/23/1986

Expiration Date

07/31/2008

City

CHICAGO

State

Zip

60625

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2008