JILLIAN L THEOBALD MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125057942

License Status

EXPIRED

Business

Title

First Name

JILLIAN

Middle

Last Name

THEOBALD

Business Name

JILLIAN L THEOBALD MD

Original Issue Date

07/01/2010

Effective Date

07/01/2010

Expiration Date

06/30/2013

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

10/07/2013