TRAVIS MARK AMENGUAL Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036153670

License Status

ACTIVE

Business

First Name

TRAVIS

Middle

MARK

Last Name

AMENGUAL

Business Name

TRAVIS MARK AMENGUAL

Original Issue Date

07/10/2020

Effective Date

04/06/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60657

County

COOK

Ever Disciplined

LastModifiedDate

12/29/2025