STEPHEN PATRICK SUPPLE MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125070179

License Status

CANCELLED

Business

Title

First Name

STEPHEN

Middle

PATRICK

Last Name

SUPPLE

Business Name

STEPHEN PATRICK SUPPLE MD

Original Issue Date

07/01/2018

Effective Date

07/01/2018

Expiration Date

06/30/2020

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Diagnostic Radiology

Ever Disciplined

LastModifiedDate

05/17/2018