SUSIANI INTAN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036141185

License Status

NOT RENEWED

Business

Title

First Name

SUSIANI

Last Name

INTAN

Business Name

SUSIANI INTAN MD

Original Issue Date

07/08/2016

Effective Date

07/08/2016

Expiration Date

07/31/2017

City

CHICAGO

State

Zip

60606

County

COOK

Ever Disciplined

LastModifiedDate

06/09/2025