MARK LOREN DENZINE Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002348

License Status

NOT RENEWED

Business

First Name

MARK

Middle

LOREN

Last Name

DENZINE

Business Name

MARK LOREN DENZINE

Original Issue Date

09/23/2004

Effective Date

09/23/2004

Expiration Date

03/01/2006

City

PROSPECT HEIGHTS

State

Zip

60070

County

COOK

Ever Disciplined

LastModifiedDate

10/09/2006