KAITLIN ELIZABETH WANTA DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125063659

License Status

CANCELLED

Business

Title

First Name

KAITLIN

Middle

ELIZABETH

Last Name

WANTA

Business Name

KAITLIN ELIZABETH WANTA DO

Original Issue Date

06/22/2013

Effective Date

06/22/2013

Expiration Date

06/21/2016

City

TINLEY PARK

State

Zip

60487

County

WILL

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

03/24/2014