ANDREW TANNENBAUM MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****82

License Status

ACTIVE

Business

Title

First Name

ANDREW

Last Name

TANNENBAUM

Business Name

ANDREW TANNENBAUM MD

Original Issue Date

09/18/2018

Effective Date

04/18/2023

Expiration Date

07/31/2026

City

ROCKFORD

State

Zip

61114

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/18/2023