DANIEL THEODORE LIS JR MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****38

License Status

NOT RENEWED

Business

First Name

DANIEL

Middle

THEODORE

Last Name

LIS JR

Suffix

Business Name

DANIEL THEODORE LIS JR MD

Original Issue Date

10/15/2009

Effective Date

10/15/2009

Expiration Date

07/31/2011

City

CHICAGO

State

Zip

60657

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011