LACO LANE MACE II MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125051339

License Status

CANCELLED

Business

First Name

LACO

Middle

LANE

Last Name

MACE

Suffix

II MD

Business Name

LACO LANE MACE II MD

Original Issue Date

07/01/2006

Effective Date

07/01/2006

Expiration Date

06/30/2009

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006