BRIAN WAYNE GOELITZ MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125042905

License Status

EXPIRED

Business

First Name

BRIAN

Middle

WAYNE

Last Name

GOELITZ

Suffix

Business Name

BRIAN WAYNE GOELITZ MD

Original Issue Date

06/22/2001

Effective Date

06/22/2001

Expiration Date

06/21/2004

City

MAYWOOD

State

Zip

60153

County

COOK

Specialty/Qualifier

Diagnostic Radiology

Ever Disciplined

LastModifiedDate

09/22/2006