LANE PHILLIPS MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125070418

License Status

CANCELLED

Business

Title

First Name

LANE

Last Name

PHILLIPS

Business Name

LANE PHILLIPS MD

Original Issue Date

06/23/2017

Effective Date

06/23/2017

Expiration Date

06/22/2020

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

04/20/2017