MIRIAM MANGLANO TIERNEY 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

MIRIAM

Last Name

MANGLANO TIERNEY

Business Name

MIRIAM MANGLANO TIERNEY

Original Issue Date

06/21/2002

Effective Date

06/21/2002

Expiration Date

07/31/2005

City

BLUE ISLAND

State

Zip

60406

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006