KATHLEEN M BOTTUM Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125036751

License Status

EXPIRED

Business

First Name

KATHLEEN

Middle

Last Name

BOTTUM

Business Name

KATHLEEN M BOTTUM

Original Issue Date

06/16/1997

Effective Date

06/16/1997

Expiration Date

06/26/2002

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Ever Disciplined

LastModifiedDate

09/22/2006