ETHAN COUCKE DO - Medical Doctor License in Illinois | # 130001349

ETHAN COUCKE DO

Business Entity

EXPIRED

License Type

Medical Doctor

Description

LIMITED MEDICAL TEMPORARY PERMIT

License Number

130001349

License Status

EXPIRED

Business

N

Title

DO

First Name

ETHAN

Last Name

COUCKE

Business Name

ETHAN COUCKE DO

Original Issue Date

02/10/2020

Effective Date

02/10/2020

Expiration Date

03/09/2020

State

IL

Specialty/Qualifier

Geriatric Medicine

Ever Disciplined

N

LastModifiedDate

11/19/2020