THOMAS ANDREW BEVILACQUA MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125060174

License Status

EXPIRED

Business

Title

First Name

THOMAS

Middle

ANDREW

Last Name

BEVILACQUA

Business Name

THOMAS ANDREW BEVILACQUA MD

Original Issue Date

06/23/2011

Effective Date

06/23/2011

Expiration Date

06/22/2012

City

CHICAGO

State

Zip

60631

County

COOK

Specialty/Qualifier

Transitional Year

Ever Disciplined

LastModifiedDate

08/29/2012