EDWIN R BALLELOS Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****85

License Status

CANCELLED

Business

First Name

EDWIN

Middle

Last Name

BALLELOS

Business Name

EDWIN R BALLELOS

Original Issue Date

03/12/1996

Effective Date

03/12/1996

Expiration Date

07/31/2002

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006