JACK S HAVDALA MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****51

License Status

CANCELLED

Business

First Name

JACK S

Last Name

HAVDALA

Suffix

Business Name

JACK S HAVDALA MD

Original Issue Date

03/09/1993

Effective Date

03/09/1993

Expiration Date

07/31/2005

City

LINCOLNWOOD

State

Zip

60712

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006