SUMA JACOB MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125046466

License Status

CANCELLED

Business

First Name

SUMA

Last Name

JACOB

Suffix

Business Name

SUMA JACOB MD

Original Issue Date

07/01/2003

Effective Date

07/01/2003

Expiration Date

06/30/2005

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Psychiatry

Ever Disciplined

LastModifiedDate

09/22/2006