AUGUSTO ALBERTO MIRAVALLE MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125047180

License Status

EXPIRED

Business

First Name

AUGUSTO

Middle

ALBERTO

Last Name

MIRAVALLE

Suffix

Business Name

AUGUSTO ALBERTO MIRAVALLE MD

Original Issue Date

06/22/2004

Effective Date

06/22/2004

Expiration Date

06/30/2007

City

CHICAGO

State

Zip

60612

Specialty/Qualifier

Neurology

Ever Disciplined

LastModifiedDate

07/03/2007