MIENTJE AGATHA B DEVRYER 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

MIENTJE

Middle

AGATHA B

Last Name

DEVRYER

Business Name

MIENTJE AGATHA B DEVRYER MD

Original Issue Date

01/01/1997

Effective Date

06/22/2011

Expiration Date

07/31/2014

City

WILMETTE

State

Zip

60091

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014