SUSAN D VAN DE WATER Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125019435

License Status

EXPIRED

Business

First Name

SUSAN

Middle

Last Name

VAN DE WATER

Business Name

SUSAN D VAN DE WATER

Original Issue Date

06/18/1986

Effective Date

06/18/1986

Expiration Date

06/24/1990

City

CHICAGO

State

Zip

60611

County

COOK

Ever Disciplined

LastModifiedDate

09/22/2006