DAN VONGTAMA MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125048005

License Status

EXPIRED

Business

Title

First Name

DAN

Last Name

VONGTAMA

Business Name

DAN VONGTAMA MD

Original Issue Date

06/21/2004

Effective Date

06/21/2004

Expiration Date

06/20/2005

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006