TITO A CHAMPENA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036044640

License Status

NOT RENEWED

Business

First Name

TITO A

Last Name

CHAMPENA

Suffix

Business Name

TITO A CHAMPENA MD

Original Issue Date

08/09/1971

Effective Date

05/08/2017

Expiration Date

09/30/2020

City

FLOSSMOOR

State

Zip

60422

County

COOK

Ever Disciplined

LastModifiedDate

01/14/2021