KATHARINE DANIELS VAN FOSSEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036148832

License Status

NOT RENEWED

Business

Title

First Name

KATHARINE

Middle

DANIELS

Last Name

VAN FOSSEN

Business Name

KATHARINE DANIELS VAN FOSSEN MD

Original Issue Date

03/28/2019

Effective Date

03/28/2019

Expiration Date

09/30/2020

City

GERMANTOWN

State

Zip

53022

County

WISCONSIN

Ever Disciplined

LastModifiedDate

01/14/2021