BO T HEADLAM Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125040534

License Status

EXPIRED

Business

First Name

Middle

Last Name

HEADLAM

Business Name

BO T HEADLAM

Original Issue Date

07/01/2000

Effective Date

07/01/2000

Expiration Date

06/30/2003

City

MAYWOOD

State

Zip

60153

County

COOK

Ever Disciplined

LastModifiedDate

09/22/2006