JACQUELINE M CHAMPLAIN Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036134052

License Status

NOT RENEWED

Business

First Name

JACQUELINE

Middle

Last Name

CHAMPLAIN

Business Name

JACQUELINE M CHAMPLAIN

Original Issue Date

10/07/2013

Effective Date

06/11/2014

Expiration Date

07/31/2017

City

CHICAGO

State

Zip

60638

County

COOK

Ever Disciplined

LastModifiedDate

11/01/2017