SUPALUCK KANJANAUTHAI MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125049698

License Status

CANCELLED

Business

First Name

SUPALUCK

Last Name

KANJANAUTHAI

Suffix

Business Name

SUPALUCK KANJANAUTHAI MD

Original Issue Date

07/01/2005

Effective Date

07/01/2005

Expiration Date

06/30/2008

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

09/22/2006