COLLEEN M LEAVITT MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125036152

License Status

EXPIRED

Business

First Name

COLLEEN

Middle

Last Name

LEAVITT

Suffix

Business Name

COLLEEN M LEAVITT MD

Original Issue Date

05/19/1997

Effective Date

05/19/1997

Expiration Date

06/21/2000

City

MAYWOOD

State

Zip

60153

County

COOK

Ever Disciplined

LastModifiedDate

09/22/2006