BENJAMIN AUGUSTIN NESSEIM MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125048663

License Status

CANCELLED

Business

First Name

BENJAMIN

Middle

AUGUSTIN

Last Name

NESSEIM

Suffix

Business Name

BENJAMIN AUGUSTIN NESSEIM MD

Original Issue Date

07/01/2004

Effective Date

07/01/2004

Expiration Date

06/30/2007

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006