MIMI EVADNE VAN DER LEDEN MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****96

License Status

CANCELLED

Business

Title

First Name

MIMI

Middle

EVADNE

Last Name

VAN DER LEDEN

Business Name

MIMI EVADNE VAN DER LEDEN MD

Original Issue Date

10/17/1997

Effective Date

10/17/1997

Expiration Date

07/31/2002

City

CHICAGO

State

Zip

60634

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020