KRISTIN MARIE VAN GENDEREN MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125062646

License Status

CANCELLED

Business

Title

First Name

KRISTIN

Middle

MARIE

Last Name

VAN GENDEREN

Business Name

KRISTIN MARIE VAN GENDEREN MD

Original Issue Date

06/23/2013

Effective Date

06/23/2013

Expiration Date

06/22/2016

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

03/24/2014