LEE MICHAEL TISA DPM Podiatrist License verification

Business Entity

NOT RENEWED

License Type

Podiatrist

Description

LICENSED PODIATRY CONTROLLED SUBSTANCE

License Number

31*****76

License Status

NOT RENEWED

Business

First Name

LEE

Middle

MICHAEL

Last Name

TISA

Suffix

DPM

Business Name

LEE MICHAEL TISA DPM

Original Issue Date

09/01/1982

Effective Date

09/01/1982

Expiration Date

01/31/2005

City

GURNEE

State

Zip

60031

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006