THEODORE BALSAM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036039020

License Status

NOT RENEWED

Business

First Name

THEODORE

Last Name

BALSAM

Suffix

Business Name

THEODORE BALSAM MD

Original Issue Date

05/21/1964

Effective Date

06/11/2020

Expiration Date

07/31/2023

City

CHICAGO

State

Zip

60640

County

COOK

Ever Disciplined

LastModifiedDate

11/30/2023