TITTO THUNDIYIL IDICULA MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125045148

License Status

CANCELLED

Business

First Name

TITTO

Middle

THUNDIYIL

Last Name

IDICULA

Suffix

Business Name

TITTO THUNDIYIL IDICULA MD

Original Issue Date

06/25/2002

Effective Date

06/25/2002

Expiration Date

06/24/2005

City

CHICAGO

State

Zip

60616

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006