ANDREW A GUSTAFSON MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125075826

License Status

CANCELLED

Business

Title

First Name

ANDREW

Middle

Last Name

GUSTAFSON

Business Name

ANDREW A GUSTAFSON MD

Original Issue Date

06/21/2020

Effective Date

06/21/2020

Expiration Date

06/20/2023

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

04/27/2020