TARA LYN PETERSEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036126053

License Status

NOT RENEWED

Business

Title

First Name

TARA

Middle

LYN

Last Name

PETERSEN

Business Name

TARA LYN PETERSEN MD

Original Issue Date

06/14/2010

Effective Date

06/30/2011

Expiration Date

07/31/2014

City

PARK RIDGE

State

Zip

60068

County

COOK

Ever Disciplined

LastModifiedDate

11/17/2014