MARK NOEL VILLANUEVA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****91

License Status

NOT RENEWED

Business

First Name

MARK

Middle

NOEL

Last Name

VILLANUEVA

Suffix

Business Name

MARK NOEL VILLANUEVA MD

Original Issue Date

06/04/2010

Effective Date

06/04/2010

Expiration Date

07/31/2011

City

MAYWOOD

State

Zip

60153

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011