BEN MANIWATANA MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125057446

License Status

EXPIRED

Business

Title

First Name

BEN

Last Name

MANIWATANA

Business Name

BEN MANIWATANA MD

Original Issue Date

07/01/2013

Effective Date

07/01/2013

Expiration Date

06/30/2014

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Anesthesiology

Ever Disciplined

LastModifiedDate

03/13/2015