BRAD L SUPRENANT DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125017116

License Status

EXPIRED

Business

First Name

BRAD L

Last Name

SUPRENANT

Suffix

Business Name

BRAD L SUPRENANT DO

Original Issue Date

06/22/1984

Effective Date

06/22/1984

Expiration Date

07/01/1986

City

CHICAGO

State

Zip

60615

County

COOK

Specialty/Qualifier

Family Practice & OMT

Ever Disciplined

LastModifiedDate

09/22/2006