MARIA L BAISA Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036090566

License Status

NOT RENEWED

Business

First Name

MARIA L

Last Name

BAISA

Business Name

MARIA L BAISA

Original Issue Date

04/25/1995

Effective Date

04/11/2017

Expiration Date

09/30/2020

City

CHAMPAIGN

State

Zip

61822

County

CHAMPAIGN

Ever Disciplined

LastModifiedDate

01/14/2021