ELIZABETH NICOLE GROOTHUIS MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125059129

License Status

CANCELLED

Business

Title

First Name

ELIZABETH

Middle

NICOLE

Last Name

GROOTHUIS

Business Name

ELIZABETH NICOLE GROOTHUIS MD

Original Issue Date

06/23/2011

Effective Date

06/23/2011

Expiration Date

06/22/2014

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

03/24/2014