ANSEL T TJIN A TAM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****22

License Status

NOT RENEWED

Business

Title

First Name

ANSEL

Middle

Last Name

TJIN A TAM

Business Name

ANSEL T TJIN A TAM MD

Original Issue Date

04/30/2013

Effective Date

04/15/2014

Expiration Date

07/31/2017

City

CHICAGO

State

Zip

60614

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020