BRENT ERIC VAN TIL DPM Podiatrist License verification

Business Entity

EXPIRED

License Type

Podiatrist

Description

TEMPORARY PODIATRIC PHYSICIAN

License Number

135000668

License Status

EXPIRED

Business

Title

DPM

First Name

BRENT

Middle

ERIC

Last Name

VAN TIL

Business Name

BRENT ERIC VAN TIL DPM

Original Issue Date

07/28/2008

Effective Date

07/01/2008

Expiration Date

06/30/2009

City

CHICAGO

State

Zip

60612

County

COOK

Ever Disciplined

LastModifiedDate

07/01/2009