ERIC MICHAEL MASAC IMOTO DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125058406

License Status

CANCELLED

Business

Title

First Name

ERIC

Middle

MICHAEL MASAC

Last Name

IMOTO

Business Name

ERIC MICHAEL MASAC IMOTO DO

Original Issue Date

06/24/2010

Effective Date

06/24/2010

Expiration Date

06/23/2013

City

OAK LAWN

State

Zip

60453

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

04/15/2010