MARC T AWOBULUYI MD (Credential# 563537) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is June 1, 2020. The license expiration date date is May 31, 2021. The license status is ACTIVE.
MARC T AWOBULUYI MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.045955. The credential type is physician/surgeon. The effective date is June 1, 2020. The expiration date is May 31, 2021. The business address is 1620 Northwest Blvd #202, Coeur D'alene, ID 83814-2488. The current status is active.
| Licensee Name | MARC T AWOBULUYI MD |
| Credential ID | 563537 |
| Credential Number | 1.045955 |
| Credential Type | Physician/Surgeon |
| Business Address |
1620 Northwest Blvd #202 Coeur D'alene ID 83814-2488 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2007-10-26 |
| Effective Date | 2020-06-01 |
| Expiration Date | 2021-05-31 |
| Refresh Date | 2020-03-04 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 505882 | CSP.0043673 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2008-06-18 | 2011-03-01 - 2013-02-28 | INACTIVE |
| Street Address | 1620 Northwest Blvd #202 |
| City | Coeur d'Alene |
| State | ID |
| Zip Code | 83814-2488 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Howard M Rosner | 1620 Northwest Blvd #202, Coeur D'alene, ID 83814 | Physician/surgeon | 2020-01-01 ~ 2020-12-31 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Santiago Jimenez | 1620 Northwest Blvd Ste 202, Coeur D Alene, ID 83814-2488 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Reono Bertagnolli | 1620 Northwest Blvd Ste 202, Coeur D Alene, ID 83814-2488 | Physician/surgeon | 2019-09-01 ~ 2020-08-31 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Dhawal A Goradia | 1839 N. Government Way, Coeur D'alene, ID 83814 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Cody Lee Ray | 1387 Kaleigh Ct, Coeur D'alene, ID 83814 | Pharmacist | 2020-02-01 ~ 2022-01-31 |
| Lawrence D Bub Md | 601 Front Ave #400, Coeur D Alene, ID 83814 | Controlled Substance Registration for Practitioner | 2011-03-01 ~ 2013-02-28 |
| Thomas B Jones Md | 601 Front Ave., #502, Coeur D Alene, ID 83814 | Controlled Substance Registration for Practitioner | 2011-03-01 ~ 2013-02-28 |
| Christopher J Miller Md | 601 Front Avenue, Suite 400, Coeur D Alene, ID 83814 | Controlled Substance Registration for Practitioner | 2011-03-01 ~ 2013-02-28 |
| David G Drake | C/o Nighthawk Radiology Services, Coeur D'alene, ID 83814 | Physician/surgeon | 2010-02-01 ~ 2011-01-31 |
| Robin Prasad Md | 250 Northwest Blvd #202, Coeur D Alene, ID 83814 | Controlled Substance Registration for Practitioner | 2008-03-01 ~ 2009-02-28 |
| Doreen M Seal · Christiansen | 1121 Shorwood Court, Coeur D Alene, ID 83814 | Licensed Practical Nurse | 2003-03-21 ~ 2004-03-31 |
| David D Burdette Md | 601 Front Ave #400, Coeur D Alene, ID 83814 | Controlled Substance Registration for Practitioner | 2011-03-01 ~ 2013-02-28 |
| Jamlik O Johnson | C/o Nighthawk Radiology Services, Coeur D' Alene, ID 83814 | Physician/surgeon | 2008-01-14 ~ 2009-02-28 |
| Find all Licenses in zip 83814 | |||
| City | Coeur d'Alene |
| Zip Code | 83814 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + Coeur d'Alene |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Marc J Parnes | 893 Central Ave, Woodmere, NY 11598-2146 | Physician/surgeon | ~ |
| Marc J Taylor | P.o. Box 814, Southbury, CT 06488 | Physician/surgeon | 2012-05-01 ~ 2013-04-30 |
| Birgit Kovacs | 19 Marc Rd, Danbury, CT 06810 | Physician/surgeon | 2019-11-01 ~ 2020-10-31 |
| Weston Jon-marc | 544 W Umpqua St Ste 203, Roseburg, OR 97471-2964 | Physician/surgeon | 1988-03-11 ~ 1988-06-30 |
| Marc P Ramirez Md | 300 Kensington Ave, New Britain, CT 06051 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Marc Moreau | 14 Cambridge Rd, Amarillo, TX 79124 | Physician/surgeon | 2017-02-01 ~ 2018-01-31 |
| Marc A Borenstein | 21 Cardinal Pl., Mt. Kisco, NY 10549 | Physician/surgeon | 2012-11-01 ~ 2013-10-31 |
| Marc Goldberg Md | 605 West Ave, Norwalk, CT 06850 | Physician/surgeon | 1996-05-24 ~ 1997-05-31 |
| Marc Schwartz Do | 555 Kappock St Apt 2r, Riverdale, NY 10463 | Physician/surgeon | 2007-02-23 ~ 2008-04-30 |
| Marc J Bayer | 10 Wyndemere, Avon, CT 06001-3959 | Physician/surgeon | 2016-05-01 ~ 2017-04-30 |
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| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).