JILLIAN L THEOBALD MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036132528

License Status

NOT RENEWED

Business

Title

First Name

JILLIAN

Middle

Last Name

THEOBALD

Business Name

JILLIAN L THEOBALD MD

Original Issue Date

04/19/2013

Effective Date

04/10/2014

Expiration Date

07/31/2017

City

FOREST PARK

State

Zip

60130

County

COOK

Ever Disciplined

LastModifiedDate

11/01/2017