KRYSTAL THOMAS SAMUEL DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125056298

License Status

CANCELLED

Business

Title

First Name

KRYSTAL

Middle

THOMAS

Last Name

SAMUEL

Business Name

KRYSTAL THOMAS SAMUEL DO

Original Issue Date

06/22/2009

Effective Date

06/22/2009

Expiration Date

06/21/2012

City

PLAINFIELD

State

Zip

60585

County

WILL

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

05/26/2009