PRINCE PANNIPUZHA MATHEW MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125055856

License Status

EXPIRED

Business

Title

First Name

PRINCE

Middle

PANNIPUZHA

Last Name

MATHEW

Business Name

PRINCE PANNIPUZHA MATHEW MD

Original Issue Date

07/01/2009

Effective Date

07/01/2009

Expiration Date

06/30/2012

City

CHICAGO

State

Zip

60616

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

08/29/2012