JACQUELYN TARA BUSSE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****82

License Status

NOT RENEWED

Business

First Name

JACQUELYN

Middle

TARA

Last Name

BUSSE

Suffix

Business Name

JACQUELYN TARA BUSSE MD

Original Issue Date

05/08/2009

Effective Date

05/08/2009

Expiration Date

07/31/2011

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011