AMBARISH MUKUND ATHAVALE MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125053927

License Status

CANCELLED

Business

First Name

AMBARISH

Middle

MUKUND

Last Name

ATHAVALE

Suffix

Business Name

AMBARISH MUKUND ATHAVALE MD

Original Issue Date

07/01/2008

Effective Date

07/01/2008

Expiration Date

06/30/2011

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

03/13/2008