KRISTEN DIANE SMITH MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125055924

License Status

CANCELLED

Business

Title

First Name

KRISTEN

Middle

DIANE

Last Name

SMITH

Business Name

KRISTEN DIANE SMITH MD

Original Issue Date

06/24/2009

Effective Date

06/24/2009

Expiration Date

06/23/2012

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

05/11/2009