MONIQUE RAE ICE Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****88

License Status

CANCELLED

Business

First Name

MONIQUE

Middle

RAE

Last Name

ICE

Business Name

MONIQUE RAE ICE

Original Issue Date

02/04/2005

Effective Date

02/04/2005

Expiration Date

07/31/2005

City

CHICAGO

State

Zip

60611

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006