TRACEY L CORNELLA CARLSON Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****56

License Status

NOT RENEWED

Business

First Name

TRACEY L

Last Name

CORNELLA CARLSON

Business Name

TRACEY L CORNELLA CARLSON

Original Issue Date

12/06/1994

Effective Date

12/06/1994

Expiration Date

07/31/2002

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006