LATANIA KISA LOGAN Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125044536

License Status

EXPIRED

Business

First Name

LATANIA

Middle

KISA

Last Name

LOGAN

Business Name

LATANIA KISA LOGAN

Original Issue Date

06/17/2002

Effective Date

06/17/2002

Expiration Date

06/16/2005

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

09/22/2006