TIRA CHAICHA-BROM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****55

License Status

NOT RENEWED

Business

Title

First Name

TIRA

Last Name

CHAICHA-BROM

Business Name

TIRA CHAICHA-BROM MD

Original Issue Date

10/14/2010

Effective Date

05/11/2011

Expiration Date

07/31/2014

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014