LISA R MACK Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****80

License Status

NOT RENEWED

Business

First Name

LISA

Middle

Last Name

MACK

Business Name

LISA R MACK

Original Issue Date

09/21/1998

Effective Date

09/21/1998

Expiration Date

07/31/1999

City

CHICAGO

State

Zip

60631

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006