LISA CHANEL JACKSON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****87

License Status

NOT RENEWED

Business

First Name

LISA

Middle

CHANEL

Last Name

JACKSON

Suffix

Business Name

LISA CHANEL JACKSON MD

Original Issue Date

05/31/2005

Effective Date

06/12/2014

Expiration Date

07/31/2017

City

EVERGREEN PARK

State

Zip

60805

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020