CRYSTAL ANN MEDINA MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125062296

License Status

CANCELLED

Business

Title

First Name

CRYSTAL

Middle

ANN

Last Name

MEDINA

Business Name

CRYSTAL ANN MEDINA MD

Original Issue Date

06/28/2012

Effective Date

06/28/2012

Expiration Date

06/27/2015

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

03/24/2014