ERIC A KIVISTO DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125024084

License Status

EXPIRED

Business

First Name

ERIC A

Last Name

KIVISTO

Suffix

Business Name

ERIC A KIVISTO DO

Original Issue Date

06/17/1989

Effective Date

06/17/1989

Expiration Date

06/22/1992

City

CHICAGO

State

Zip

60615

County

COOK

Specialty/Qualifier

Family Practice & OMT

Ever Disciplined

LastModifiedDate

09/22/2006