BRIAN JOSEPH BANSIDHAR DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125038456

License Status

CANCELLED

Business

First Name

BRIAN

Middle

JOSEPH

Last Name

BANSIDHAR

Suffix

Business Name

BRIAN JOSEPH BANSIDHAR DO

Original Issue Date

07/01/1998

Effective Date

07/01/1998

Expiration Date

06/30/2001

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006