CHRISTINE MARIE MATA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****77

License Status

NOT RENEWED

Business

Title

First Name

CHRISTINE

Middle

MARIE

Last Name

MATA

Business Name

CHRISTINE MARIE MATA MD

Original Issue Date

06/18/2014

Effective Date

06/18/2014

Expiration Date

07/31/2017

City

GURNEE

State

Zip

60031

County

LAKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020