Indiana
Professional Licensing Agency
TIN HLA
Controlled Substance Registration - Physician
License number
01034070B
Date granted
02/28/1986
Date expires
06/30/2001
Class
Controlled Substance Registration - Physician
Status
Expired
Address
1507 WABASH STREET, MICHIGAN CITY IN 46360
indianalicensing.org
ID 5893827
LAST UPDATED 2024-05-09 17:15:51 UTC
LAST UPDATED 2024-05-09 17:15:51 UTC
This website is unaffiliated with the Professional Licensing Agency. Please verify all information directly with the relevant official government authority.