NATHANIEL KYLE BALLEK MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125053294

License Status

CANCELLED

Business

Title

First Name

NATHANIEL

Middle

KYLE

Last Name

BALLEK

Business Name

NATHANIEL KYLE BALLEK MD

Original Issue Date

06/25/2010

Effective Date

06/25/2010

Expiration Date

06/24/2012

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Urology

Ever Disciplined

LastModifiedDate

06/02/2010