Indiana
Professional Licensing Agency
Ted J. Crisman
Controlled Substance Registration - Physician
License number
01030303B
Date granted
09/30/1986
Date expires
10/31/2015
Class
Controlled Substance Registration - Physician
Status
Active
Address
Lutheran Medical Group, 401South Broad Street, Suite B, Fremont IN 46737
indianalicensing.org
ID 5855837
LAST UPDATED 2024-04-08 01:59:14 UTC
LAST UPDATED 2024-04-08 01:59:14 UTC
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