ELLEN MICHELLE MLOT DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125061610

License Status

CANCELLED

Business

Title

First Name

ELLEN

Middle

MICHELLE

Last Name

MLOT

Business Name

ELLEN MICHELLE MLOT DO

Original Issue Date

06/22/2012

Effective Date

06/22/2012

Expiration Date

06/21/2015

City

ELGIN

State

Zip

60120

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

03/24/2014