MADISON SAMPLE JR Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125029245

License Status

EXPIRED

Business

First Name

MADISON

Last Name

SAMPLE JR

Business Name

MADISON SAMPLE JR

Original Issue Date

04/12/1993

Effective Date

04/12/1993

Expiration Date

06/30/1996

City

CHICAGO

State

Zip

60612

County

COOK

Ever Disciplined

LastModifiedDate

05/02/2013