THEODORE R FORD MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****31

License Status

NOT RENEWED

Business

First Name

THEODORE R

Last Name

FORD

Suffix

Business Name

THEODORE R FORD MD

Original Issue Date

05/28/1993

Effective Date

05/28/1993

Expiration Date

07/31/1996

City

CHICAGO

State

Zip

60611

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006