LINE JOHANSEN SRINIVASAN MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****29

License Status

ACTIVE

Business

Title

First Name

LINE

Middle

JOHANSEN

Last Name

SRINIVASAN

Business Name

LINE JOHANSEN SRINIVASAN MD

Original Issue Date

08/15/2012

Effective Date

05/31/2023

Expiration Date

07/31/2026

City

PARK RIDGE

State

Zip

60068

County

LAKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/31/2023