MICHAEL A COSTINE Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****77

License Status

INOPERATIVE

Business

First Name

MICHAEL

Middle

Last Name

COSTINE

Business Name

MICHAEL A COSTINE

Original Issue Date

11/14/2019

Effective Date

01/21/2020

Expiration Date

03/01/2022

City

CHICAGO

State

Zip

60611

County

COOK

Ever Disciplined

LastModifiedDate

01/03/2022