MARK I DEBRUIN Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125020752

License Status

EXPIRED

Business

First Name

MARK

Middle

Last Name

DEBRUIN

Business Name

MARK I DEBRUIN

Original Issue Date

05/08/1987

Effective Date

05/08/1987

Expiration Date

07/01/1990

City

CHICAGO

State

Zip

60615

County

COOK

Specialty/Qualifier

Family Practice & OMT

Ever Disciplined

LastModifiedDate

09/22/2006