STANFORD R TACK MD 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

STANFORD R

Last Name

TACK

Suffix

Business Name

STANFORD R TACK MD

Original Issue Date

11/07/1988

Effective Date

05/14/2014

Expiration Date

07/31/2017

City

BUFFALO GROVE

State

Zip

60089

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020