TINA MAI THAO PHAN DO Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036139021

License Status

INACTIVE

Business

Title

First Name

TINA

Middle

MAI THAO

Last Name

PHAN

Business Name

TINA MAI THAO PHAN DO

Original Issue Date

08/26/2015

Effective Date

08/26/2015

Expiration Date

07/31/2017

City

CHICAGO

State

Zip

60611

County

COOK

Ever Disciplined

LastModifiedDate

04/12/2017