EDWIN R BALLELOS Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125027727

License Status

EXPIRED

Business

First Name

EDWIN

Middle

Last Name

BALLELOS

Business Name

EDWIN R BALLELOS

Original Issue Date

04/24/1992

Effective Date

04/24/1992

Expiration Date

06/30/1995

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

09/22/2006