NICHOLAS ALEXANDER BORM MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125056347

License Status

EXPIRED

Business

Title

First Name

NICHOLAS

Middle

ALEXANDER

Last Name

BORM

Business Name

NICHOLAS ALEXANDER BORM MD

Original Issue Date

06/23/2012

Effective Date

06/23/2012

Expiration Date

06/22/2013

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

10/07/2013