LATANIA KISA LOGAN Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****76

License Status

ACTIVE

Business

First Name

LATANIA

Middle

KISA

Last Name

LOGAN

Business Name

LATANIA KISA LOGAN

Original Issue Date

06/15/2005

Effective Date

04/09/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/09/2023