JAN L IWATA Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****99

License Status

NOT RENEWED

Business

First Name

JAN L

Last Name

IWATA

Business Name

JAN L IWATA

Original Issue Date

01/17/2003

Effective Date

01/17/2003

Expiration Date

07/31/2005

City

NORTHFIELD

State

Zip

60093

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020