KRYSTAL ALTHEA WIDAU DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125060380

License Status

EXPIRED

Business

Title

First Name

KRYSTAL

Middle

ALTHEA

Last Name

WIDAU

Business Name

KRYSTAL ALTHEA WIDAU DO

Original Issue Date

08/07/2014

Effective Date

08/07/2014

Expiration Date

09/24/2014

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

03/13/2015