TATYANA RASHELLE DEMIDOVICH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****07

License Status

NOT RENEWED

Business

First Name

TATYANA

Middle

RASHELLE

Last Name

DEMIDOVICH

Suffix

Business Name

TATYANA RASHELLE DEMIDOVICH MD

Original Issue Date

06/28/2004

Effective Date

01/07/2009

Expiration Date

07/31/2011

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/12/2017