GIAVONNI MYSTIQUE LEWIS MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125049276

License Status

EXPIRED

Business

First Name

GIAVONNI

Middle

MYSTIQUE

Last Name

LEWIS

Suffix

Business Name

GIAVONNI MYSTIQUE LEWIS MD

Original Issue Date

07/13/2008

Effective Date

07/13/2008

Expiration Date

07/12/2010

City

MAYWOOD

State

Zip

60153

County

COOK

Specialty/Qualifier

General Surgery

Ever Disciplined

LastModifiedDate

08/05/2010