TARA A BROCKMAN MD 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

Title

First Name

TARA

Middle

Last Name

BROCKMAN

Business Name

TARA A BROCKMAN MD

Original Issue Date

06/07/2022

Effective Date

06/07/2022

Expiration Date

07/31/2023

City

CHICAGO

State

Zip

60642

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023