BRENDON J PHALEN Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036108024

License Status

NOT RENEWED

Business

First Name

BRENDON

Middle

Last Name

PHALEN

Business Name

BRENDON J PHALEN

Original Issue Date

10/16/2002

Effective Date

10/16/2002

Expiration Date

07/31/2005

City

CHICAGO

State

Zip

60637

County

COOK

Ever Disciplined

LastModifiedDate

10/09/2006