AMANDA HOPE CHAMPLAIN MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125066256

License Status

EXPIRED

Business

Title

First Name

AMANDA

Middle

HOPE

Last Name

CHAMPLAIN

Business Name

AMANDA HOPE CHAMPLAIN MD

Original Issue Date

07/01/2015

Effective Date

07/01/2015

Expiration Date

06/30/2018

City

MAYWOOD

State

Zip

60153

County

COOK

Specialty/Qualifier

Dermatology

Ever Disciplined

LastModifiedDate

10/25/2018