PED BUNSONGSIKUL Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125036363

License Status

EXPIRED

Business

First Name

PED

Last Name

BUNSONGSIKUL

Business Name

PED BUNSONGSIKUL

Original Issue Date

05/29/1997

Effective Date

05/29/1997

Expiration Date

06/30/2000

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006