LISA M FORTMAN Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125023724

License Status

EXPIRED

Business

First Name

LISA

Middle

Last Name

FORTMAN

Business Name

LISA M FORTMAN

Original Issue Date

05/10/1989

Effective Date

05/10/1989

Expiration Date

06/30/1992

City

HINSDALE

State

Zip

60521

County

DUPAGE

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006