ELISE ANJALEE DE BRUYN MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125080647

License Status

CANCELLED

Business

Title

First Name

ELISE

Middle

ANJALEE

Last Name

DE BRUYN

Business Name

ELISE ANJALEE DE BRUYN MD

Original Issue Date

07/01/2023

Effective Date

07/01/2023

Expiration Date

06/30/2025

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Interventional Radiology - Integrated

Ever Disciplined

LastModifiedDate

05/22/2025