BENJAMIN N LACROSSE MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125067240

License Status

EXPIRED

Business

Title

First Name

BENJAMIN

Middle

Last Name

LACROSSE

Business Name

BENJAMIN N LACROSSE MD

Original Issue Date

06/23/2015

Effective Date

06/23/2015

Expiration Date

06/22/2016

City

CHICAGO

State

Zip

60631

County

COOK

Specialty/Qualifier

Transitional Year

Ever Disciplined

LastModifiedDate

08/16/2016