JAN L IWATA Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****10

License Status

INACTIVE

Business

First Name

JAN L

Last Name

IWATA

Business Name

JAN L IWATA

Original Issue Date

12/31/2002

Effective Date

06/27/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60640

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/27/2023