SUPREMA T DANCEL Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125025282

License Status

EXPIRED

Business

First Name

SUPREMA

Middle

Last Name

DANCEL

Business Name

SUPREMA T DANCEL

Original Issue Date

06/01/1990

Effective Date

06/01/1990

Expiration Date

06/22/1993

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

09/22/2006