CHRISTOPHER BRYANT FORMANEK DPM Podiatrist License verification

Business Entity

NOT RENEWED

License Type

Podiatrist

Description

LICENSED PODIATRY CONTROLLED SUBSTANCE

License Number

31*****98

License Status

NOT RENEWED

Business

First Name

CHRISTOPHER

Middle

BRYANT

Last Name

FORMANEK

Suffix

DPM

Business Name

CHRISTOPHER BRYANT FORMANEK DPM

Original Issue Date

09/06/2002

Effective Date

09/06/2002

Expiration Date

01/31/2005

City

CHICAGO

State

Zip

60622

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006