BOGUSLAW BONCZAK MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125053459

License Status

CANCELLED

Business

Title

First Name

BOGUSLAW

Last Name

BONCZAK

Business Name

BOGUSLAW BONCZAK MD

Original Issue Date

07/01/2007

Effective Date

07/01/2007

Expiration Date

06/30/2010

City

MCHENRY

State

Zip

60050

County

MCHENRY

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

06/04/2007