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DEPARTMENT OF INSURANCE
Affiliations
Name
Supan, Mitra
DOIID
980856
NAIC NPN
18661850
License - Line of Authority Information
Status
Residency
Class
Line of Authority
Active Date
Inactive Date
License Expiration Date
Inactive
Non Resident
Agent
Life
1/5/2018
5/31/2019
Inactive
Non Resident
Agent
Health
1/5/2018
5/31/2019
* If a status Is
Pending, Pending Replacement
,Or the record displays
Affidavit On File
, click On them For more details.
Appointments with the following Insurers
Status
Affiliation Name
DOI Number
Line of Authority
Active Date
Inactive Date
Inactive
Freedom Life Insurance Company of America
300074
Agent - Health
1/20/2018
2/26/2019
Inactive
Freedom Life Insurance Company of America
300074
Agent - Life
1/20/2018
2/26/2019
Inactive
LifeShield National Insurance Company
737111
Agent - Health
3/26/2019
5/31/2019
Inactive
Lumico Life Insurance Company
300354
Agent - Health
9/12/2018
11/15/2018
Inactive
Lumico Life Insurance Company
300354
Agent - Life
4/1/2019
5/31/2019
Designated to act on behalf of the following Business Entities
Status
Affiliation Name
DOI Number
Line of Authority
Active Date
Inactive Date
Denied
Health Plan Intermediaries Holdings
786463
Agent - Health
Inactive
Ushealth Advisors Llc
713288
Agent - Health
1/20/2018
2/26/2019
Inactive
Ushealth Advisors Llc
713288
Agent - Life
1/20/2018
2/26/2019
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