SUSAN LYNN BARDOLPH MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125065525

License Status

CANCELLED

Business

First Name

SUSAN

Middle

LYNN

Last Name

BARDOLPH

Suffix

Business Name

SUSAN LYNN BARDOLPH MD

Original Issue Date

06/22/2014

Effective Date

06/22/2014

Expiration Date

06/21/2017

City

MAYWOOD

State

Zip

60153

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

06/17/2014