EDWARD M GONG MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125044507

License Status

CANCELLED

Business

First Name

EDWARD

Middle

Last Name

GONG

Suffix

Business Name

EDWARD M GONG MD

Original Issue Date

06/24/2002

Effective Date

06/24/2002

Expiration Date

06/30/2007

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Urology

Ever Disciplined

LastModifiedDate

09/22/2006