GAUTAM D DESAI Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125021504

License Status

EXPIRED

Business

First Name

GAUTAM D

Last Name

DESAI

Business Name

GAUTAM D DESAI

Original Issue Date

07/02/1987

Effective Date

07/02/1987

Expiration Date

07/01/1990

City

SPRINGFIELD

State

Zip

62708

County

SANGAMON

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006