TINA MAI THAO PHAN DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125061857

License Status

CANCELLED

Business

Title

First Name

TINA

Middle

MAI THAO

Last Name

PHAN

Business Name

TINA MAI THAO PHAN DO

Original Issue Date

06/20/2012

Effective Date

06/20/2012

Expiration Date

06/19/2015

City

BERWYN

State

Zip

60402

County

COOK

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

03/24/2014