SAM B TACKE Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125014317

License Status

EXPIRED

Business

First Name

SAM

Middle

Last Name

TACKE

Business Name

SAM B TACKE

Original Issue Date

06/17/1982

Effective Date

06/17/1982

Expiration Date

06/25/1984

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Addiction Psychiatry

Ever Disciplined

LastModifiedDate

09/22/2006