TIM S PROVIAS MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036129441

License Status

ACTIVE

Business

Title

First Name

TIM

Middle

Last Name

PROVIAS

Business Name

TIM S PROVIAS MD

Original Issue Date

01/09/2012

Effective Date

07/11/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60611

County

COOK

Ever Disciplined

LastModifiedDate

07/11/2023