DIANA BOLOTIN MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125051066

License Status

CANCELLED

Business

First Name

DIANA

Last Name

BOLOTIN

Suffix

Business Name

DIANA BOLOTIN MD

Original Issue Date

07/01/2009

Effective Date

07/01/2009

Expiration Date

06/30/2010

City

CHICAGO

State

Zip

60637

Specialty/Qualifier

Dermatology

Ever Disciplined

LastModifiedDate

02/23/2009