BALTAZARA G LOTUACO MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****67

License Status

NOT RENEWED

Business

First Name

BALTAZARA

Middle

Last Name

LOTUACO

Suffix

Business Name

BALTAZARA G LOTUACO MD

Original Issue Date

11/29/2005

Effective Date

11/29/2005

Expiration Date

07/31/2008

City

CHAMPAIGN

State

Zip

61820

County

CHAMPAIGN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2008