DAVID E NISSAN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****13

License Status

NOT RENEWED

Business

First Name

DAVID E

Last Name

NISSAN

Suffix

Business Name

DAVID E NISSAN MD

Original Issue Date

08/31/1987

Effective Date

08/31/1987

Expiration Date

07/31/1990

City

CHICAGO

State

Zip

60646

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020