COSTNER MCKENZIE MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125076103

License Status

EXPIRED

Business

Title

First Name

COSTNER

Last Name

MCKENZIE

Business Name

COSTNER MCKENZIE MD

Original Issue Date

06/24/2020

Effective Date

06/24/2020

Expiration Date

06/23/2021

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Transitional Year

Ever Disciplined

LastModifiedDate

10/11/2022