TIMOTHY AUSTIN LANE MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125067641

License Status

CANCELLED

Business

Title

First Name

TIMOTHY

Middle

AUSTIN

Last Name

LANE

Business Name

TIMOTHY AUSTIN LANE MD

Original Issue Date

07/01/2015

Effective Date

07/01/2015

Expiration Date

06/30/2018

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

06/15/2015