PUANGPETH JANTRA MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036052761

License Status

INACTIVE

Business

First Name

PUANGPETH

Last Name

JANTRA

Suffix

Business Name

PUANGPETH JANTRA MD

Original Issue Date

05/14/1976

Effective Date

05/13/2014

Expiration Date

07/31/2017

City

NORTHBROOK

State

Zip

60062

County

COOK

Ever Disciplined

LastModifiedDate

04/11/2017