GLEN EDWIN D SOUZA MD - Medical Doctor License in Illinois | # 125085013

GLEN EDWIN D SOUZA MD

Business Entity

ACTIVE

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125085013

License Status

ACTIVE

Business

N

Title

MD

First Name

GLEN

Middle

EDWIN

Last Name

D SOUZA

Business Name

GLEN EDWIN D SOUZA MD

Original Issue Date

08/01/2024

Effective Date

08/01/2024

Expiration Date

07/31/2025

State

IL

Specialty/Qualifier

Advanced Rhinology Fellowship

Ever Disciplined

N

LastModifiedDate

07/05/2024