AMBARISH MUKUND ATHAVALE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036127463

License Status

NOT RENEWED

Business

First Name

AMBARISH

Middle

MUKUND

Last Name

ATHAVALE

Suffix

Business Name

AMBARISH MUKUND ATHAVALE MD

Original Issue Date

04/05/2011

Effective Date

06/10/2020

Expiration Date

07/31/2023

City

CHICAGO

State

Zip

60612

County

COOK

Ever Disciplined

LastModifiedDate

11/30/2023