TINA HOMER PITHAWALLA MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125048908

License Status

CANCELLED

Business

First Name

TINA

Middle

HOMER

Last Name

PITHAWALLA

Suffix

Business Name

TINA HOMER PITHAWALLA MD

Original Issue Date

06/22/2005

Effective Date

06/22/2005

Expiration Date

06/21/2008

City

CHICAGO

State

Zip

60657

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006