BENJAMIN N LARSEN MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125062957

License Status

EXPIRED

Business

Title

First Name

BENJAMIN

Middle

Last Name

LARSEN

Business Name

BENJAMIN N LARSEN MD

Original Issue Date

07/01/2016

Effective Date

07/01/2016

Expiration Date

06/30/2018

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Diagnostic Radiology

Ever Disciplined

LastModifiedDate

10/25/2018