ETHAN COUCKE DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

LIMITED MEDICAL TEMPORARY PERMIT

License Number

130001349

License Status

EXPIRED

Business

Title

First Name

ETHAN

Last Name

COUCKE

Business Name

ETHAN COUCKE DO

Original Issue Date

02/10/2020

Effective Date

02/10/2020

Expiration Date

03/09/2020

City

CHICAGO

State

Zip

60612

Specialty/Qualifier

Geriatric Medicine

Ever Disciplined

LastModifiedDate

11/19/2020