NATHAN ANDREW MALL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036128187

License Status

NOT RENEWED

Business

Title

First Name

NATHAN

Middle

ANDREW

Last Name

MALL

Business Name

NATHAN ANDREW MALL MD

Original Issue Date

06/23/2011

Effective Date

06/23/2011

Expiration Date

07/31/2014

City

OAK PARK

State

Zip

60302

County

COOK

Ever Disciplined

LastModifiedDate

11/17/2014