THEODORE TAE SHIK PARK MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****06

License Status

ACTIVE

Business

Title

First Name

THEODORE

Middle

TAE SHIK

Last Name

PARK

Business Name

THEODORE TAE SHIK PARK MD

Original Issue Date

07/18/2013

Effective Date

07/19/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60623

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/19/2023