ANDREA VIVIANA BRETAL MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125053696

License Status

CANCELLED

Business

First Name

ANDREA

Middle

VIVIANA

Last Name

BRETAL

Suffix

Business Name

ANDREA VIVIANA BRETAL MD

Original Issue Date

06/21/2007

Effective Date

06/21/2007

Expiration Date

06/24/2010

City

CHICAGO

State

Zip

60616

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

05/22/2007