TAD MARK JOHNSON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036139238

License Status

NOT RENEWED

Business

Title

First Name

TAD

Middle

MARK

Last Name

JOHNSON

Business Name

TAD MARK JOHNSON MD

Original Issue Date

10/09/2015

Effective Date

10/09/2015

Expiration Date

07/31/2017

City

MUSKEGO

State

Zip

53150

County

WISCONSIN

Ever Disciplined

LastModifiedDate

11/01/2017