POTHEN JACOB MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****62

License Status

NOT RENEWED

Business

First Name

POTHEN

Last Name

JACOB

Suffix

Business Name

POTHEN JACOB MD

Original Issue Date

09/06/1988

Effective Date

09/06/1988

Expiration Date

07/31/1990

City

CHICAGO

State

Zip

60611

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006