TASHEEMA LANELL FAIR MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****76

License Status

NOT RENEWED

Business

Title

First Name

TASHEEMA

Middle

LANELL

Last Name

FAIR

Business Name

TASHEEMA LANELL FAIR MD

Original Issue Date

10/21/2019

Effective Date

10/21/2019

Expiration Date

09/30/2020

City

MACOMB

State

Zip

61455

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021