LARISA ANN BROGLIE MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125058371

License Status

CANCELLED

Business

Title

First Name

LARISA

Middle

ANN

Last Name

BROGLIE

Business Name

LARISA ANN BROGLIE MD

Original Issue Date

06/23/2010

Effective Date

06/23/2010

Expiration Date

06/22/2013

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

04/22/2010