SAMANTHA RENEE PENA CHAVEZ MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125065471

License Status

CANCELLED

Business

Title

First Name

SAMANTHA

Middle

RENEE

Last Name

PENA CHAVEZ

Business Name

SAMANTHA RENEE PENA CHAVEZ MD

Original Issue Date

07/01/2014

Effective Date

07/01/2014

Expiration Date

06/30/2017

City

MORTON GROVE

State

Zip

60053

County

COOK

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

06/17/2014