TIFFANY M WILLARD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****00

License Status

NOT RENEWED

Business

First Name

TIFFANY

Middle

Last Name

WILLARD

Business Name

TIFFANY M WILLARD

Original Issue Date

03/31/2006

Effective Date

03/31/2006

Expiration Date

07/31/2008

City

CHICAGO

State

Zip

60657

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2008