KOICHI TAKEDA Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125029081

License Status

EXPIRED

Business

First Name

KOICHI

Last Name

TAKEDA

Business Name

KOICHI TAKEDA

Original Issue Date

07/30/1992

Effective Date

07/30/1992

Expiration Date

07/29/1994

City

PEORIA

State

Zip

61603

County

PEORIA

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006