MARA GRACE BEVERIDGE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****72

License Status

NOT RENEWED

Business

Title

First Name

MARA

Middle

GRACE

Last Name

BEVERIDGE

Business Name

MARA GRACE BEVERIDGE MD

Original Issue Date

02/23/2015

Effective Date

05/23/2017

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

01/14/2021