SAMANTHA ANNE BOLZ MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125073811

License Status

EXPIRED

Business

Title

First Name

SAMANTHA

Middle

ANNE

Last Name

BOLZ

Business Name

SAMANTHA ANNE BOLZ MD

Original Issue Date

06/21/2019

Effective Date

06/21/2019

Expiration Date

06/20/2022

City

BERWYN

State

Zip

60402

County

COOK

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

10/11/2022