AUGUSTIN V VITUALLA JR MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036056239

License Status

INACTIVE

Business

First Name

AUGUSTIN V

Last Name

VITUALLA JR

Suffix

Business Name

AUGUSTIN V VITUALLA JR MD

Original Issue Date

12/16/1977

Effective Date

12/16/1977

Expiration Date

07/31/1987

City

CHICAGO

State

Zip

60649

County

COOK

Ever Disciplined

LastModifiedDate

09/20/2006