DANA MICHELLE GUSTAFSON DPM Podiatrist License verification

Business Entity

CANCELLED

License Type

Podiatrist

Description

TEMPORARY PODIATRIC PHYSICIAN

License Number

135001016

License Status

CANCELLED

Business

Title

DPM

First Name

DANA

Middle

MICHELLE

Last Name

GUSTAFSON

Business Name

DANA MICHELLE GUSTAFSON DPM

Original Issue Date

06/25/2018

Effective Date

06/25/2018

Expiration Date

06/25/2021

City

CHICAGO

State

Zip

60622

County

COOK

Ever Disciplined

LastModifiedDate

05/30/2018