KRISTIN MARIE VAN GENDEREN MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****20

License Status

ACTIVE

Business

Title

First Name

KRISTIN

Middle

MARIE

Last Name

VAN GENDEREN

Business Name

KRISTIN MARIE VAN GENDEREN MD

Original Issue Date

09/23/2020

Effective Date

05/16/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60611

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/16/2023