MARILYN M LACROSSE Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125026950

License Status

EXPIRED

Business

First Name

MARILYN

Middle

Last Name

LACROSSE

Business Name

MARILYN M LACROSSE

Original Issue Date

05/28/1991

Effective Date

05/28/1991

Expiration Date

06/30/1994

City

LIBERTYVILLE

State

Zip

60048

County

LAKE

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006