MARIAH NICHOL MANZANARES MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****70

License Status

NOT RENEWED

Business

First Name

MARIAH

Middle

NICHOL

Last Name

MANZANARES

Suffix

Business Name

MARIAH NICHOL MANZANARES MD

Original Issue Date

12/13/2001

Effective Date

12/13/2001

Expiration Date

07/31/2005

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006