MITCHELL A JACKSON MD 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

MITCHELL

Middle

Last Name

JACKSON

Suffix

Business Name

MITCHELL A JACKSON MD

Original Issue Date

08/18/1999

Effective Date

08/18/1999

Expiration Date

07/31/2005

City

CHICAGO

State

Zip

60611

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020