MARIO D MIRANDA DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****75

License Status

ACTIVE

Business

First Name

MARIO

Middle

Last Name

MIRANDA

Suffix

Business Name

MARIO D MIRANDA DO

Original Issue Date

10/17/1997

Effective Date

06/09/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61606

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/09/2023