MARIA REPUBLICA BALLEZA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036065806

License Status

NOT RENEWED

Business

First Name

MARIA REPUBLICA

Last Name

BALLEZA

Suffix

Business Name

MARIA REPUBLICA BALLEZA MD

Original Issue Date

12/21/1982

Effective Date

12/21/1982

Expiration Date

07/31/1993

City

CHICAGO

State

Zip

60618

County

COOK

Ever Disciplined

LastModifiedDate

09/20/2006