MYRIAH W MATHISEN Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036107920

License Status

NOT RENEWED

Business

First Name

MYRIAH

Middle

Last Name

MATHISEN

Business Name

MYRIAH W MATHISEN

Original Issue Date

09/25/2002

Effective Date

09/25/2002

Expiration Date

07/31/2005

City

CHICAGO

State

Zip

60657

County

COOK

Ever Disciplined

LastModifiedDate

10/09/2006