TIMOTHY GERARD VANDENBOOM MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125062313

License Status

EXPIRED

Business

Title

First Name

TIMOTHY

Middle

GERARD

Last Name

VANDENBOOM

Business Name

TIMOTHY GERARD VANDENBOOM MD

Original Issue Date

07/01/2012

Effective Date

07/01/2012

Expiration Date

06/30/2015

City

MAYWOOD

State

Zip

60153

County

COOK

Specialty/Qualifier

Pathology

Ever Disciplined

LastModifiedDate

09/04/2015