FAUSTO R LORA MIR Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****95

License Status

NOT RENEWED

Business

First Name

FAUSTO R

Last Name

LORA MIR

Business Name

FAUSTO R LORA MIR

Original Issue Date

03/16/1993

Effective Date

06/27/2011

Expiration Date

07/31/2014

City

COUNTRYSIDE

State

Zip

60525

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014