NICOLE KATHRYN LONG MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125079023

License Status

CANCELLED

Business

Title

First Name

NICOLE

Middle

KATHRYN

Last Name

LONG

Business Name

NICOLE KATHRYN LONG MD

Original Issue Date

07/03/2024

Effective Date

07/03/2024

Expiration Date

07/02/2026

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

General Surgery

Ever Disciplined

LastModifiedDate

02/09/2026