ANDREA DIANE BIRNBAUM MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125049535

License Status

CANCELLED

Business

First Name

ANDREA

Middle

DIANE

Last Name

BIRNBAUM

Suffix

Business Name

ANDREA DIANE BIRNBAUM MD

Original Issue Date

07/01/2008

Effective Date

07/01/2008

Expiration Date

06/30/2009

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Ophthalmology

Ever Disciplined

LastModifiedDate

04/09/2009