MONTHA SUPHANGUL MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125052160

License Status

CANCELLED

Business

First Name

MONTHA

Last Name

SUPHANGUL

Suffix

Business Name

MONTHA SUPHANGUL MD

Original Issue Date

08/01/2006

Effective Date

08/01/2006

Expiration Date

07/31/2009

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006