AMIT SANTOSH DATE MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125049364

License Status

EXPIRED

Business

First Name

AMIT

Middle

SANTOSH

Last Name

DATE

Suffix

Business Name

AMIT SANTOSH DATE MD

Original Issue Date

06/25/2008

Effective Date

06/25/2008

Expiration Date

06/24/2010

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Otolaryngology

Ever Disciplined

LastModifiedDate

06/24/2010