Indiana
Professional Licensing Agency
Northeast Indiana Pediatric
Medical Licensing Board - Medical Corporation
License number
50004150A
Date granted
06/17/1999
Date expires
01/31/2014
Class
Medical Licensing Board - Medical Corporation
Status
Expired
Address
SPECIALISTS P C MED BUILDING 1, 7900 W JEFFERSON BLVD #308, FORT WAYNE IN 46804
indianalicensing.org
ID 24826828
LAST UPDATED 2024-05-17 02:14:41 UTC
LAST UPDATED 2024-05-17 02:14:41 UTC
This website is unaffiliated with the Professional Licensing Agency. Please verify all information directly with the relevant official government authority.