CHRISTOPHER BRYANT FORMANEK DPM Podiatrist License verification

Business Entity

NOT RENEWED

License Type

Podiatrist

Description

LICENSED PODIATRIC PHYSICIAN

License Number

016005097

License Status

NOT RENEWED

Business

First Name

CHRISTOPHER

Middle

BRYANT

Last Name

FORMANEK

Suffix

DPM

Business Name

CHRISTOPHER BRYANT FORMANEK DPM

Original Issue Date

08/27/2002

Effective Date

08/27/2002

Expiration Date

01/31/2005

City

CHICAGO

State

Zip

60610

County

COOK

Ever Disciplined

LastModifiedDate

10/09/2006