THOMAS M LEAVENWORTH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****44

License Status

NOT RENEWED

Business

First Name

THOMAS M

Last Name

LEAVENWORTH

Suffix

Business Name

THOMAS M LEAVENWORTH MD

Original Issue Date

03/16/1993

Effective Date

03/16/1993

Expiration Date

07/31/1993

City

GALESBURG

State

Zip

61401

County

KNOX

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006