MARY COLLEEN COSTELLO MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****80

License Status

NOT RENEWED

Business

First Name

MARY

Middle

COLLEEN

Last Name

COSTELLO

Suffix

Business Name

MARY COLLEEN COSTELLO MD

Original Issue Date

06/27/2007

Effective Date

06/27/2007

Expiration Date

07/31/2008

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2011