TARA LYN PETERSEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****32

License Status

NOT RENEWED

Business

Title

First Name

TARA

Middle

LYN

Last Name

PETERSEN

Business Name

TARA LYN PETERSEN MD

Original Issue Date

06/15/2010

Effective Date

06/15/2010

Expiration Date

07/31/2011

City

CHICAGO

State

Zip

60614

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011