MARILYN M LACROSSE Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****48

License Status

ACTIVE

Business

First Name

MARILYN

Middle

Last Name

LACROSSE

Business Name

MARILYN M LACROSSE

Original Issue Date

12/11/2007

Effective Date

06/12/2023

Expiration Date

07/31/2026

City

LIBERTYVILLE

State

Zip

60048

County

LAKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/12/2023