ALEXANDRA ROSE GRACE Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LIMITED MEDICAL TEMPORARY PERMIT

License Number

130001011

License Status

CANCELLED

Business

First Name

ALEXANDRA

Middle

ROSE

Last Name

GRACE

Business Name

ALEXANDRA ROSE GRACE

Original Issue Date

08/01/2014

Effective Date

08/01/2014

Expiration Date

08/31/2014

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Gastroenterology

Ever Disciplined

LastModifiedDate

03/13/2015