TERENCE LOU DALLO AGUSTIN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****99

License Status

NOT RENEWED

Business

First Name

TERENCE LOU

Middle

DALLO

Last Name

AGUSTIN

Suffix

Business Name

TERENCE LOU DALLO AGUSTIN MD

Original Issue Date

12/31/2009

Effective Date

04/18/2011

Expiration Date

07/31/2014

City

CHICAGO

State

Zip

60608

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/11/2017