CONRAD GRANT VANHAZEBROECK DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125053143

License Status

CANCELLED

Business

Title

First Name

CONRAD

Middle

GRANT

Last Name

VANHAZEBROECK

Business Name

CONRAD GRANT VANHAZEBROECK DO

Original Issue Date

07/01/2007

Effective Date

07/01/2007

Expiration Date

06/30/2010

City

ELK GROVE VILLAGE

State

Zip

60007

County

COOK

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

05/29/2007