ELIZABETH D BASHAM MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125054745

License Status

EXPIRED

Business

Title

First Name

ELIZABETH

Middle

Last Name

BASHAM

Business Name

ELIZABETH D BASHAM MD

Original Issue Date

06/23/2011

Effective Date

06/23/2011

Expiration Date

06/22/2012

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Obstetrics & Gynecology

Ever Disciplined

LastModifiedDate

08/29/2012