NATHAN JOSEPH STACKHOUSE MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125064097

License Status

CANCELLED

Business

First Name

NATHAN

Middle

JOSEPH

Last Name

STACKHOUSE

Suffix

Business Name

NATHAN JOSEPH STACKHOUSE MD

Original Issue Date

07/01/2013

Effective Date

07/01/2013

Expiration Date

06/30/2016

City

CHICAGO

State

Zip

60608

County

COOK

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

03/24/2014