PREM LATA PAUL MD

Business Entity
NOT RENEWED

Medical Doctor

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

33*****70

NOT RENEWED

N

PREM LATA

PAUL

MD

PREM LATA PAUL MD

01/01/1997

08/20/2008

07/31/2011

CHICAGO

IL

60601

COOK

II III IV V

N

04/12/2017