MATTHEW R ANDERSEN Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125046326

License Status

CANCELLED

Business

First Name

MATTHEW

Middle

Last Name

ANDERSEN

Business Name

MATTHEW R ANDERSEN

Original Issue Date

06/24/2003

Effective Date

06/24/2003

Expiration Date

06/23/2006

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006