KENNETH J BOOMGAARD - Medical Doctor License in Illinois | # 125043183

KENNETH J BOOMGAARD

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125043183

License Status

EXPIRED

Business

N

First Name

KENNETH

Middle

J

Last Name

BOOMGAARD

Business Name

KENNETH J BOOMGAARD

Original Issue Date

07/01/2001

Effective Date

07/01/2001

Expiration Date

06/30/2004

State

IL

Specialty/Qualifier

Family Medicine

Ever Disciplined

N

LastModifiedDate

09/22/2006