ANTONIO B BAUTISTA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036045520

License Status

NOT RENEWED

Business

First Name

ANTONIO B

Last Name

BAUTISTA

Suffix

Business Name

ANTONIO B BAUTISTA MD

Original Issue Date

03/27/1972

Effective Date

07/31/2006

Expiration Date

07/31/2008

City

SKOKIE

State

Zip

60076

County

COOK

Ever Disciplined

LastModifiedDate

11/06/2008