SUSAN JACOB MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125043641

License Status

EXPIRED

Business

Title

First Name

SUSAN

Last Name

JACOB

Business Name

SUSAN JACOB MD

Original Issue Date

07/05/2001

Effective Date

07/05/2001

Expiration Date

07/04/2004

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006