AUGUSTINE S PARK Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036108701

License Status

NOT RENEWED

Business

First Name

AUGUSTINE

Middle

Last Name

PARK

Business Name

AUGUSTINE S PARK

Original Issue Date

03/04/2003

Effective Date

03/04/2003

Expiration Date

07/31/2005

City

CHICAGO

State

Zip

60657

County

COOK

Ever Disciplined

LastModifiedDate

10/09/2006