NICHOLAS JOEL GUSTAFSON DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125065138

License Status

CANCELLED

Business

Title

First Name

NICHOLAS

Middle

JOEL

Last Name

GUSTAFSON

Business Name

NICHOLAS JOEL GUSTAFSON DO

Original Issue Date

07/01/2017

Effective Date

07/01/2017

Expiration Date

06/30/2018

City

OLYMPIA FIELDS

State

Zip

60461

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

05/18/2017