PORNTHEP PRATHANVANICH MD - Medical Doctor License in Illinois | # 125066961

PORNTHEP PRATHANVANICH MD

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125066961

License Status

EXPIRED

Business

N

Title

MD

First Name

PORNTHEP

Last Name

PRATHANVANICH

Business Name

PORNTHEP PRATHANVANICH MD

Original Issue Date

06/22/2016

Effective Date

06/22/2016

Expiration Date

06/21/2017

City

MAYWOOD

State

IL

Zip

60153

County

COOK

Specialty/Qualifier

General Surgery

Ever Disciplined

N

LastModifiedDate

09/19/2017