STEPHENIE MARIE TAKAHASHI 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

First Name

STEPHENIE

Middle

MARIE

Last Name

TAKAHASHI

Suffix

Business Name

STEPHENIE MARIE TAKAHASHI MD

Original Issue Date

03/23/2009

Effective Date

04/22/2011

Expiration Date

07/31/2014

City

CHICAGO

State

Zip

60640

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014