EDWARD BASTA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036036192

License Status

NOT RENEWED

Business

First Name

EDWARD

Last Name

BASTA

Suffix

Business Name

EDWARD BASTA MD

Original Issue Date

11/19/1959

Effective Date

11/19/1959

Expiration Date

07/31/1990

City

CHICAGO

State

Zip

60639

County

COOK

Ever Disciplined

LastModifiedDate

09/20/2006