STEPHANIE A DETTERLINE MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125044356

License Status

EXPIRED

Business

First Name

STEPHANIE

Middle

Last Name

DETTERLINE

Suffix

Business Name

STEPHANIE A DETTERLINE MD

Original Issue Date

06/22/2002

Effective Date

06/22/2002

Expiration Date

06/21/2005

City

BERWYN

State

Zip

60402

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006