GWYNNE DANIA CHURCH MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125039550

License Status

CANCELLED

Business

First Name

GWYNNE

Middle

DANIA

Last Name

CHURCH

Suffix

Business Name

GWYNNE DANIA CHURCH MD

Original Issue Date

07/01/1999

Effective Date

07/01/1999

Expiration Date

06/30/2002

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

09/22/2006