MARY PATRICIA FORKIN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****90

License Status

NOT RENEWED

Business

First Name

MARY PATRICIA

Last Name

FORKIN

Suffix

Business Name

MARY PATRICIA FORKIN MD

Original Issue Date

11/18/1981

Effective Date

11/18/1981

Expiration Date

07/31/1987

City

GIBSON CITY

State

Zip

60936

County

FORD

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006