MARLENE A MANTICH Podiatrist License verification

Business Entity

NOT RENEWED

License Type

Podiatrist

Description

LICENSED PODIATRY CONTROLLED SUBSTANCE

License Number

31*****40

License Status

NOT RENEWED

Business

First Name

MARLENE A

Last Name

MANTICH

Business Name

MARLENE A MANTICH

Original Issue Date

10/11/1995

Effective Date

01/30/2017

Expiration Date

01/31/2019

City

EVERGREEN PARK

State

Zip

60805

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/28/2019