AUGUSTINE S PARK Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125039910

License Status

EXPIRED

Business

First Name

AUGUSTINE

Middle

Last Name

PARK

Business Name

AUGUSTINE S PARK

Original Issue Date

06/22/1999

Effective Date

06/22/1999

Expiration Date

06/28/2003

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Anesthesiology

Ever Disciplined

LastModifiedDate

09/22/2006