NICOLE MARIE BAUTISTA MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125055752

License Status

EXPIRED

Business

Title

First Name

NICOLE

Middle

MARIE

Last Name

BAUTISTA

Business Name

NICOLE MARIE BAUTISTA MD

Original Issue Date

07/01/2009

Effective Date

07/01/2009

Expiration Date

06/30/2012

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

08/29/2012