LARA MASULLO ELLISON DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125045981

License Status

EXPIRED

Business

First Name

LARA

Middle

MASULLO

Last Name

ELLISON

Suffix

Business Name

LARA MASULLO ELLISON DO

Original Issue Date

06/16/2003

Effective Date

06/16/2003

Expiration Date

06/15/2006

City

BERWYN

State

Zip

60402

County

COOK

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006