MOANIS K H BASTAWROUS MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125056915

License Status

CANCELLED

Business

Title

First Name

MOANIS

Middle

K H

Last Name

BASTAWROUS

Business Name

MOANIS K H BASTAWROUS MD

Original Issue Date

07/01/2009

Effective Date

07/01/2009

Expiration Date

06/30/2012

City

NORTH CHICAGO

State

Zip

60064

County

LAKE

Specialty/Qualifier

Psychiatry

Ever Disciplined

LastModifiedDate

05/21/2009