BRENT ERIC VAN TIL DPM Podiatrist License verification

Business Entity

NOT RENEWED

License Type

Podiatrist

Description

LICENSED PODIATRY CONTROLLED SUBSTANCE

License Number

31*****56

License Status

NOT RENEWED

Business

Title

DPM

First Name

BRENT

Middle

ERIC

Last Name

VAN TIL

Business Name

BRENT ERIC VAN TIL DPM

Original Issue Date

10/15/2009

Effective Date

02/15/2011

Expiration Date

01/31/2013

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/20/2013