LEAH M VAN SLAMBROUCK Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125056774

License Status

CANCELLED

Business

First Name

LEAH

Middle

Last Name

VAN SLAMBROUCK

Business Name

LEAH M VAN SLAMBROUCK

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

05/21/2009