DEEPIKA BONGU - Medical Doctor License in Illinois | # 125039982

DEEPIKA BONGU

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125039982

License Status

EXPIRED

Business

N

First Name

DEEPIKA

Last Name

BONGU

Business Name

DEEPIKA BONGU

Original Issue Date

07/01/1999

Effective Date

07/01/1999

Expiration Date

06/30/2002

State

IL

Specialty/Qualifier

Family Medicine

Ever Disciplined

N

LastModifiedDate

09/22/2006