ADDIS MEKONNEN MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125079544

License Status

CANCELLED

Business

Title

First Name

ADDIS

Last Name

MEKONNEN

Business Name

ADDIS MEKONNEN MD

Original Issue Date

06/13/2022

Effective Date

06/13/2022

Expiration Date

06/12/2025

City

LOVES PARK

State

Zip

61111

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

03/04/2025