MARCO T BOLOGNA Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****73

License Status

NOT RENEWED

Business

First Name

MARCO

Middle

Last Name

BOLOGNA

Business Name

MARCO T BOLOGNA

Original Issue Date

09/27/2002

Effective Date

09/27/2002

Expiration Date

07/31/2005

City

CHICAGO

State

Zip

60657

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2011