JARED P HANSEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****74

License Status

NOT RENEWED

Business

Title

First Name

JARED

Middle

Last Name

HANSEN

Business Name

JARED P HANSEN MD

Original Issue Date

08/04/2017

Effective Date

08/04/2017

Expiration Date

09/30/2020

City

NEW LENOX

State

Zip

60451

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021