LAURIE G BROUTMAN Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****02

License Status

INACTIVE

Business

First Name

LAURIE

Middle

Last Name

BROUTMAN

Business Name

LAURIE G BROUTMAN

Original Issue Date

01/18/1991

Effective Date

06/21/2017

Expiration Date

09/30/2020

City

NORTH CHICAGO

State

Zip

60064

County

LAKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020