MA THERESA V EGASANI-ELISES MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125053276

License Status

CANCELLED

Business

Title

First Name

MA THERESA

Middle

Last Name

EGASANI-ELISES

Business Name

MA THERESA V EGASANI-ELISES MD

Original Issue Date

07/01/2007

Effective Date

07/01/2007

Expiration Date

06/30/2010

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

11/10/2009