JENNIFER K TAKATA DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****21

License Status

NOT RENEWED

Business

First Name

JENNIFER

Middle

Last Name

TAKATA

Suffix

Business Name

JENNIFER K TAKATA DO

Original Issue Date

10/14/1999

Effective Date

10/14/1999

Expiration Date

07/31/2008

City

ARLINGTON HEIGHTS

State

Zip

60004

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2008