ANSEL T TJIN A TAM MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125057190

License Status

CANCELLED

Business

Title

First Name

ANSEL

Middle

Last Name

TJIN A TAM

Business Name

ANSEL T TJIN A TAM MD

Original Issue Date

07/01/2009

Effective Date

07/01/2009

Expiration Date

06/30/2012

City

CHICAGO

State

Zip

60614

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

01/15/2016