PORNTHEP TANPOWPONG MD - Medical Doctor License in Illinois | # 125050111

PORNTHEP TANPOWPONG MD

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125050111

License Status

CANCELLED

Business

N

First Name

PORNTHEP

Last Name

TANPOWPONG

Suffix

MD

Business Name

PORNTHEP TANPOWPONG MD

Original Issue Date

07/01/2005

Effective Date

07/01/2005

Expiration Date

06/30/2008

City

CHICAGO

State

IL

Zip

60612

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

N

LastModifiedDate

09/22/2006