DANIEL OLIN BROUSSEAU DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125038993

License Status

EXPIRED

Business

First Name

DANIEL

Middle

OLIN

Last Name

BROUSSEAU

Suffix

Business Name

DANIEL OLIN BROUSSEAU DO

Original Issue Date

06/21/1999

Effective Date

06/21/1999

Expiration Date

06/20/2000

City

OLYMPIA FIELDS

State

Zip

60461

County

COOK

Ever Disciplined

LastModifiedDate

09/22/2006