KATHERINE REBECCA EXTEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****05

License Status

NOT RENEWED

Business

Title

First Name

KATHERINE

Middle

REBECCA

Last Name

EXTEN

Business Name

KATHERINE REBECCA EXTEN MD

Original Issue Date

03/13/2014

Effective Date

12/16/2014

Expiration Date

07/31/2017

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017