TAD MARK JOHNSON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****11

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

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017