TODD W BANNEN MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125034673

License Status

EXPIRED

Business

First Name

TODD

Middle

Last Name

BANNEN

Suffix

Business Name

TODD W BANNEN MD

Original Issue Date

05/23/1996

Effective Date

05/23/1996

Expiration Date

06/30/1999

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

09/22/2006