BENJAMIN AMOS BASSICHIS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036106425

License Status

NOT RENEWED

Business

First Name

BENJAMIN

Middle

AMOS

Last Name

BASSICHIS

Suffix

Business Name

BENJAMIN AMOS BASSICHIS MD

Original Issue Date

03/05/2002

Effective Date

03/05/2002

Expiration Date

07/31/2005

City

CHICAGO

State

Zip

60657

County

COOK

Ever Disciplined

LastModifiedDate

10/09/2006