MILDRED B LATHAM Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****94

License Status

ACTIVE

Business

First Name

MILDRED

Middle

Last Name

LATHAM

Business Name

MILDRED B LATHAM

Original Issue Date

12/08/2011

Effective Date

12/14/2023

Expiration Date

03/01/2026

City

CHICAGO

State

Zip

60652

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/03/2025