THEODORE EDMUND TE PAS Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****70

License Status

NOT RENEWED

Business

First Name

THEODORE EDMUND

Last Name

TE PAS

Business Name

THEODORE EDMUND TE PAS

Original Issue Date

08/19/1996

Effective Date

08/19/1996

Expiration Date

07/31/2002

City

CHICAGO

State

Zip

60661

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006