ADA X VAN VLOTEN Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125015062

License Status

EXPIRED

Business

First Name

ADA

Middle

Last Name

VAN VLOTEN

Business Name

ADA X VAN VLOTEN

Original Issue Date

10/22/1982

Effective Date

10/22/1982

Expiration Date

10/18/1984

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

09/22/2006