KEVIN BRIAN TOM DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125077952

License Status

CANCELLED

Business

Title

First Name

KEVIN

Middle

BRIAN

Last Name

TOM

Business Name

KEVIN BRIAN TOM DO

Original Issue Date

07/01/2021

Effective Date

07/01/2021

Expiration Date

06/30/2024

City

CHICAGO

State

Zip

60625

County

COOK

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

05/10/2021