TENNISON LEWIS MALCOLM MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125070809

License Status

EXPIRED

Business

Title

First Name

TENNISON

Middle

LEWIS

Last Name

MALCOLM

Business Name

TENNISON LEWIS MALCOLM MD

Original Issue Date

07/01/2017

Effective Date

07/01/2017

Expiration Date

06/30/2020

City

CHICAGO

State

Zip

60657

County

COOK

Specialty/Qualifier

Anesthesiology

Ever Disciplined

LastModifiedDate

11/19/2020