ANDREW JAMES CUSACK DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125061900

License Status

CANCELLED

Business

Title

First Name

ANDREW

Middle

JAMES

Last Name

CUSACK

Business Name

ANDREW JAMES CUSACK DO

Original Issue Date

07/01/2012

Effective Date

07/01/2012

Expiration Date

06/30/2015

City

PEORIA

State

Zip

61604

County

PEORIA

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

03/24/2014