MYLENE BERSAMINA VICUNA MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125048180

License Status

EXPIRED

Business

First Name

MYLENE

Middle

BERSAMINA

Last Name

VICUNA

Suffix

Business Name

MYLENE BERSAMINA VICUNA MD

Original Issue Date

06/22/2007

Effective Date

06/22/2007

Expiration Date

07/21/2007

City

MELROSE PARK

State

Zip

60160

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

07/25/2007