EVANGELINE CO TAN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****11

License Status

NOT RENEWED

Business

First Name

EVANGELINE

Middle

Last Name

TAN

Suffix

Business Name

EVANGELINE CO TAN MD

Original Issue Date

03/18/1986

Effective Date

03/18/1986

Expiration Date

07/31/1990

City

PALOS HILLS

State

Zip

60465

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020