LARYSA TARASHEVSKA WICKMAN Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****43

License Status

NOT RENEWED

Business

First Name

LARYSA

Middle

TARASHEVSKA

Last Name

WICKMAN

Business Name

LARYSA TARASHEVSKA WICKMAN

Original Issue Date

03/02/2007

Effective Date

03/02/2007

Expiration Date

07/31/2008

City

PARK RIDGE

State

Zip

60068

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2008