ERIC IAN ENGELHARD Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002253

License Status

NOT RENEWED

Business

First Name

ERIC

Middle

IAN

Last Name

ENGELHARD

Business Name

ERIC IAN ENGELHARD

Original Issue Date

06/29/2004

Effective Date

06/29/2004

Expiration Date

03/01/2006

City

MOUNT PROSPECT

State

Zip

60056

County

COOK

Ever Disciplined

LastModifiedDate

10/09/2006