KIRK MAURICE CHAN-TACK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****52

License Status

NOT RENEWED

Business

First Name

KIRK

Middle

MAURICE

Last Name

CHAN-TACK

Suffix

Business Name

KIRK MAURICE CHAN-TACK MD

Original Issue Date

08/20/2001

Effective Date

08/20/2001

Expiration Date

07/31/2005

City

HINSDALE

State

Zip

60521

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006