ELLEN D WALTHALL MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125024818

License Status

EXPIRED

Business

First Name

ELLEN D

Last Name

WALTHALL

Suffix

Business Name

ELLEN D WALTHALL MD

Original Issue Date

05/16/1990

Effective Date

05/16/1990

Expiration Date

06/25/1993

City

CHICAGO

State

Zip

60657

County

COOK

Specialty/Qualifier

General Surgery

Ever Disciplined

LastModifiedDate

09/22/2006