DAVID ALLEN SUPIK Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125062796

License Status

EXPIRED

Business

First Name

DAVID

Middle

ALLEN

Last Name

SUPIK

Business Name

DAVID ALLEN SUPIK

Original Issue Date

07/01/2013

Effective Date

07/01/2013

Expiration Date

06/30/2016

City

CHICAGO

State

Zip

60657

County

COOK

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

08/16/2016