NICOLE MARIE BAUTISTA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036130766

License Status

NOT RENEWED

Business

Title

First Name

NICOLE

Middle

MARIE

Last Name

BAUTISTA

Business Name

NICOLE MARIE BAUTISTA MD

Original Issue Date

07/06/2012

Effective Date

07/06/2012

Expiration Date

07/31/2014

City

CHICAGO

State

Zip

60647

County

COOK

Ever Disciplined

LastModifiedDate

11/17/2014