AMPICA MANGKLABRUKS Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125020666

License Status

EXPIRED

Business

First Name

AMPICA

Last Name

MANGKLABRUKS

Business Name

AMPICA MANGKLABRUKS

Original Issue Date

05/04/1987

Effective Date

05/04/1987

Expiration Date

07/01/1990

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006