ERLEINE FAYE BAUTISTA MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125053458

License Status

CANCELLED

Business

Title

First Name

ERLEINE

Middle

FAYE

Last Name

BAUTISTA

Business Name

ERLEINE FAYE BAUTISTA MD

Original Issue Date

06/22/2010

Effective Date

06/22/2010

Expiration Date

06/21/2011

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Obstetrics & Gynecology

Ever Disciplined

LastModifiedDate

04/14/2010