BONITA L BROCKMAN Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125032930

License Status

EXPIRED

Business

First Name

BONITA

Middle

Last Name

BROCKMAN

Business Name

BONITA L BROCKMAN

Original Issue Date

06/01/1995

Effective Date

06/01/1995

Expiration Date

06/18/1998

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

09/22/2006