EDWARD NICHOLAS NORTHRUP MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125074710

License Status

CANCELLED

Business

Title

First Name

EDWARD

Middle

NICHOLAS

Last Name

NORTHRUP

Business Name

EDWARD NICHOLAS NORTHRUP MD

Original Issue Date

06/24/2019

Effective Date

06/24/2019

Expiration Date

06/23/2022

City

CHICAGO

State

Zip

60617

County

COOK

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

05/14/2019