DOUGLAS JAMES MATHISEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****72

License Status

NOT RENEWED

Business

First Name

DOUGLAS JAMES

Last Name

MATHISEN

Suffix

Business Name

DOUGLAS JAMES MATHISEN MD

Original Issue Date

08/01/1983

Effective Date

08/01/1983

Expiration Date

07/31/1987

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006