MIZUHO STACY MIMOTO MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****88

License Status

NOT RENEWED

Business

Title

First Name

MIZUHO

Middle

STACY

Last Name

MIMOTO

Business Name

MIZUHO STACY MIMOTO MD

Original Issue Date

04/22/2015

Effective Date

05/01/2017

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021