HOLLY LONGSTREET DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125061208

License Status

CANCELLED

Business

Title

First Name

HOLLY

Last Name

LONGSTREET

Business Name

HOLLY LONGSTREET DO

Original Issue Date

07/01/2012

Effective Date

07/01/2012

Expiration Date

06/30/2015

City

LAGRANGE

State

Zip

60525

County

COOK

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

03/24/2014