AMANDA D ELLIS-PELLETIER DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125049253

License Status

CANCELLED

Business

First Name

AMANDA

Middle

Last Name

ELLIS-PELLETIER

Suffix

Business Name

AMANDA D ELLIS-PELLETIER DO

Original Issue Date

06/24/2005

Effective Date

06/24/2005

Expiration Date

06/23/2008

City

PARK RIDGE

State

Zip

60068

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

09/22/2006