BROCK L EIDE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036090110

License Status

NOT RENEWED

Business

First Name

BROCK L

Last Name

EIDE

Suffix

Business Name

BROCK L EIDE MD

Original Issue Date

01/17/1995

Effective Date

01/17/1995

Expiration Date

07/31/2002

City

HINSDALE

State

Zip

60521

County

DUPAGE

Ever Disciplined

LastModifiedDate

10/09/2006