MICHELLE DIANE LUNDHOLM MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125069993

License Status

CANCELLED

Business

Title

First Name

MICHELLE

Middle

DIANE

Last Name

LUNDHOLM

Business Name

MICHELLE DIANE LUNDHOLM MD

Original Issue Date

06/22/2017

Effective Date

06/22/2017

Expiration Date

06/21/2020

City

MAYWOOD

State

Zip

60153

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

05/01/2017