C MARK CAPISTRANO MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****84

License Status

NOT RENEWED

Business

Title

First Name

C MARK

Last Name

CAPISTRANO

Business Name

C MARK CAPISTRANO MD

Original Issue Date

05/11/2011

Effective Date

07/17/2017

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60613

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021