JAY BOUGHANEM MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125049002

License Status

CANCELLED

Business

First Name

JAY

Last Name

BOUGHANEM

Suffix

Business Name

JAY BOUGHANEM MD

Original Issue Date

06/20/2005

Effective Date

06/20/2005

Expiration Date

06/19/2008

City

CHICAGO

State

Zip

60611

County

COOK

Ever Disciplined

LastModifiedDate

06/10/2011