COLETTE A GOMEZ-KIRCHHOFF Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****76

License Status

NOT RENEWED

Business

First Name

COLETTE A

Last Name

GOMEZ-KIRCHHOFF

Business Name

COLETTE A GOMEZ-KIRCHHOFF

Original Issue Date

01/31/1996

Effective Date

01/31/1996

Expiration Date

07/31/1996

City

CHICAGO

State

Zip

60657

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006