AMITHA S MUSHYAM MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125049973

License Status

CANCELLED

Business

Title

First Name

AMITHA

Middle

Last Name

MUSHYAM

Business Name

AMITHA S MUSHYAM MD

Original Issue Date

07/01/2005

Effective Date

07/01/2005

Expiration Date

06/30/2008

City

SOUTH BARRINGTON

State

Zip

60010

County

COOK

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006