DANA MICHELLE GUSTAFSON DPM - Podiatrist License in Illinois | # 135001016

DANA MICHELLE GUSTAFSON DPM

Business Entity

CANCELLED

License Type

Podiatrist

Description

TEMPORARY PODIATRIC PHYSICIAN

License Number

135001016

License Status

CANCELLED

Business

N

Title

DPM

First Name

DANA

Middle

MICHELLE

Last Name

GUSTAFSON

Business Name

DANA MICHELLE GUSTAFSON DPM

Original Issue Date

06/25/2018

Effective Date

06/25/2018

Expiration Date

06/25/2021

State

IL

Ever Disciplined

N

LastModifiedDate

05/30/2018