ANTHONY PAUL DIBIASE Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****51

License Status

NOT RENEWED

Business

First Name

ANTHONY

Middle

PAUL

Last Name

DIBIASE

Business Name

ANTHONY PAUL DIBIASE

Original Issue Date

04/16/2002

Effective Date

08/21/2008

Expiration Date

07/31/2011

City

CHICAGO

State

Zip

60611

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011