DITTANA PHONCHAROENSRI Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036120983

License Status

NOT RENEWED

Business

First Name

DITTANA

Last Name

PHONCHAROENSRI

Business Name

DITTANA PHONCHAROENSRI

Original Issue Date

05/22/2008

Effective Date

05/22/2008

Expiration Date

07/31/2011

City

CHICAGO

State

Zip

60611

County

COOK

Ever Disciplined

LastModifiedDate

11/14/2011