TRAVIS MARK AMENGUAL - Medical Doctor License in Illinois | # 125072037

TRAVIS MARK AMENGUAL

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125072037

License Status

CANCELLED

Business

N

First Name

TRAVIS

Middle

MARK

Last Name

AMENGUAL

Business Name

TRAVIS MARK AMENGUAL

Original Issue Date

06/23/2018

Effective Date

06/23/2018

Expiration Date

06/22/2021

State

IL

Specialty/Qualifier

Psychiatry

Ever Disciplined

N

LastModifiedDate

04/11/2018