BRIAN THOMAS MICHALSEN DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125055231

License Status

CANCELLED

Business

Title

First Name

BRIAN

Middle

THOMAS

Last Name

MICHALSEN

Business Name

BRIAN THOMAS MICHALSEN DO

Original Issue Date

07/21/2008

Effective Date

07/21/2008

Expiration Date

07/20/2011

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

05/06/2008