STACIE KIKUMI HIROTA DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LIMITED MEDICAL TEMPORARY PERMIT

License Number

130001184

License Status

CANCELLED

Business

Title

First Name

STACIE

Middle

KIKUMI

Last Name

HIROTA

Business Name

STACIE KIKUMI HIROTA DO

Original Issue Date

02/12/2018

Effective Date

02/12/2018

Expiration Date

03/11/2018

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Pediatric Sports Medicine

Ever Disciplined

LastModifiedDate

06/15/2018