MIRA B KUPISEK Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****62

License Status

NOT RENEWED

Business

First Name

MIRA B

Last Name

KUPISEK

Business Name

MIRA B KUPISEK

Original Issue Date

01/25/1989

Effective Date

01/25/1989

Expiration Date

07/31/2008

City

GRAYSLAKE

State

Zip

60030

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2011