ELIZABETH RENEE VAN OPSTAL MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125055347

License Status

CANCELLED

Business

First Name

ELIZABETH

Middle

RENEE

Last Name

VAN OPSTAL

Suffix

Business Name

ELIZABETH RENEE VAN OPSTAL MD

Original Issue Date

06/24/2011

Effective Date

06/24/2011

Expiration Date

06/23/2012

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Internal Medicine/Pediatrics

Ever Disciplined

LastModifiedDate

06/09/2011