EDWARD BASTA MD - Medical Doctor License in Illinois | # 036036192

EDWARD BASTA MD

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036036192

License Status

NOT RENEWED

Business

N

First Name

EDWARD

Last Name

BASTA

Suffix

MD

Business Name

EDWARD BASTA MD

Original Issue Date

11/19/1959

Effective Date

11/19/1959

Expiration Date

07/31/1990

State

IL

Ever Disciplined

N

LastModifiedDate

09/20/2006