LISA MARIE FOGT MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125046071

License Status

EXPIRED

Business

First Name

LISA

Middle

MARIE

Last Name

FOGT

Suffix

Business Name

LISA MARIE FOGT MD

Original Issue Date

06/23/2003

Effective Date

06/23/2003

Expiration Date

06/30/2008

City

WINNETKA

State

Zip

60093

Specialty/Qualifier

Diagnostic Radiology

Ever Disciplined

LastModifiedDate

07/31/2008