GRANT K GILLEN MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125044049

License Status

EXPIRED

Business

First Name

GRANT

Middle

Last Name

GILLEN

Suffix

Business Name

GRANT K GILLEN MD

Original Issue Date

10/01/2005

Effective Date

10/01/2005

Expiration Date

09/30/2006

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Anesthesiology

Ever Disciplined

LastModifiedDate

11/03/2006