STEPHANIE A DETTERLINE MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****63

License Status

CANCELLED

Business

First Name

STEPHANIE

Middle

Last Name

DETTERLINE

Suffix

Business Name

STEPHANIE A DETTERLINE MD

Original Issue Date

05/24/2005

Effective Date

05/24/2005

Expiration Date

07/31/2008

City

MAYWOOD

State

Zip

60153

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/17/2008