MAMIE J LONG MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****85

License Status

NOT RENEWED

Business

First Name

MAMIE J

Last Name

LONG

Suffix

Business Name

MAMIE J LONG MD

Original Issue Date

01/01/1997

Effective Date

04/08/2014

Expiration Date

07/31/2017

City

CHICAGO

State

Zip

60652

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017