STANFORD R TACK MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****00

License Status

ACTIVE

Business

First Name

STANFORD R

Last Name

TACK

Suffix

Business Name

STANFORD R TACK MD

Original Issue Date

09/15/2017

Effective Date

04/11/2023

Expiration Date

07/31/2026

City

LAKE BLUFF

State

Zip

60044

County

LAKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/11/2023