LAUREL J LYCKHOLM Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****03

License Status

NOT RENEWED

Business

First Name

LAUREL J

Last Name

LYCKHOLM

Business Name

LAUREL J LYCKHOLM

Original Issue Date

09/06/1995

Effective Date

09/06/1995

Expiration Date

07/31/1996

City

CALUMET CITY

State

Zip

60409

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006