NICHOLAS ALEXANDER BORM MD - Medical Doctor License in Illinois | # 125056347

NICHOLAS ALEXANDER BORM MD

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125056347

License Status

EXPIRED

Business

N

Title

MD

First Name

NICHOLAS

Middle

ALEXANDER

Last Name

BORM

Business Name

NICHOLAS ALEXANDER BORM MD

Original Issue Date

06/23/2012

Effective Date

06/23/2012

Expiration Date

06/22/2013

State

IL

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

N

LastModifiedDate

10/07/2013