BRIDGET SUSAN BANACH MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125061495

License Status

CANCELLED

Business

Title

First Name

BRIDGET

Middle

SUSAN

Last Name

BANACH

Business Name

BRIDGET SUSAN BANACH MD

Original Issue Date

06/24/2012

Effective Date

06/24/2012

Expiration Date

06/23/2015

City

GENEVA

State

Zip

60134

County

KANE

Specialty/Qualifier

Pathology

Ever Disciplined

LastModifiedDate

03/24/2014