MARJORIE LOU FORMAN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****60

License Status

NOT RENEWED

Business

First Name

MARJORIE LOU

Last Name

FORMAN

Suffix

Business Name

MARJORIE LOU FORMAN MD

Original Issue Date

01/01/1997

Expiration Date

07/31/2002

City

GLEN ELLYN

State

Zip

60137

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006