LARYSA TARASHEVSKA WICKMAN Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125048011

License Status

EXPIRED

Business

First Name

LARYSA

Middle

TARASHEVSKA

Last Name

WICKMAN

Business Name

LARYSA TARASHEVSKA WICKMAN

Original Issue Date

06/28/2004

Effective Date

06/28/2004

Expiration Date

06/27/2007

City

PARK RIDGE

State

Zip

60068

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

07/03/2007