BEN R MALTZ Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125019582

License Status

EXPIRED

Business

First Name

BEN

Middle

Last Name

MALTZ

Business Name

BEN R MALTZ

Original Issue Date

06/18/1986

Effective Date

06/18/1986

Expiration Date

06/23/1989

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006