JONATHAN B STALLKAMP Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****20

License Status

NOT RENEWED

Business

First Name

JONATHAN

Middle

Last Name

STALLKAMP

Business Name

JONATHAN B STALLKAMP

Original Issue Date

04/15/2003

Effective Date

04/15/2003

Expiration Date

07/31/2005

City

CHICAGO

State

Zip

60611

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006