LINE JOHANSEN SRINIVASAN MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125057455

License Status

CANCELLED

Business

Title

First Name

LINE

Middle

JOHANSEN

Last Name

SRINIVASAN

Business Name

LINE JOHANSEN SRINIVASAN MD

Original Issue Date

07/01/2010

Effective Date

07/01/2010

Expiration Date

06/30/2013

City

PARK RIDGE

State

Zip

60068

County

COOK

Specialty/Qualifier

Anesthesiology

Ever Disciplined

LastModifiedDate

04/28/2010