TERENCE LOU DALLO AGUSTIN MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125050489

License Status

EXPIRED

Business

First Name

TERENCE LOU

Middle

DALLO

Last Name

AGUSTIN

Suffix

Business Name

TERENCE LOU DALLO AGUSTIN MD

Original Issue Date

10/20/2005

Effective Date

10/20/2005

Expiration Date

10/19/2008

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

11/05/2008