BANSAN TANTASAVASDI MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036048874

License Status

NOT RENEWED

Business

First Name

BANSAN

Last Name

TANTASAVASDI

Suffix

Business Name

BANSAN TANTASAVASDI MD

Original Issue Date

02/05/1974

Effective Date

02/05/1974

Expiration Date

07/01/1982

City

OAK PARK

State

Zip

60302

County

COOK

Ever Disciplined

LastModifiedDate

09/20/2006