STEPHAN LANCE FORSTOT MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036043753

License Status

NOT RENEWED

Business

First Name

STEPHAN LANCE

Last Name

FORSTOT

Suffix

Business Name

STEPHAN LANCE FORSTOT MD

Original Issue Date

09/24/1970

Effective Date

09/24/1970

City

CHICAGO

State

Zip

60613

County

COOK

Ever Disciplined

LastModifiedDate

09/20/2006