FABIO LEONIDAS URRESTA MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125045441

License Status

CANCELLED

Business

First Name

FABIO

Middle

LEONIDAS

Last Name

URRESTA

Suffix

Business Name

FABIO LEONIDAS URRESTA MD

Original Issue Date

09/24/2002

Effective Date

09/24/2002

Expiration Date

09/23/2003

City

NORTH CHICAGO

State

Zip

60064

County

LAKE

Specialty/Qualifier

Psychiatry

Ever Disciplined

LastModifiedDate

09/22/2006