JACQUELINE BROM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****42

License Status

NOT RENEWED

Business

First Name

JACQUELINE

Last Name

BROM

Suffix

Business Name

JACQUELINE BROM MD

Original Issue Date

06/13/2017

Effective Date

06/13/2017

Expiration Date

09/30/2020

City

DES PLAINES

State

Zip

60016

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021