LORA KOSIVZOFF DPM Podiatrist License verification

Business Entity

NOT RENEWED

License Type

Podiatrist

Description

LICENSED PODIATRY CONTROLLED SUBSTANCE

License Number

31*****04

License Status

NOT RENEWED

Business

First Name

LORA

Last Name

KOSIVZOFF

Suffix

DPM

Business Name

LORA KOSIVZOFF DPM

Original Issue Date

08/17/1989

Effective Date

08/17/1989

Expiration Date

01/31/1997

City

ELGIN

State

Zip

60120

County

KANE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/25/2006