SUPACHAI TANOMSUP MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036060985

License Status

NOT RENEWED

Business

First Name

SUPACHAI

Last Name

TANOMSUP

Suffix

Business Name

SUPACHAI TANOMSUP MD

Original Issue Date

09/11/1980

Effective Date

09/11/1980

Expiration Date

07/01/1982

City

ALSIP

State

Zip

60658

County

COOK

Ever Disciplined

LastModifiedDate

09/20/2006