HIRENKUMAR D ITALIA MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125060357

License Status

CANCELLED

Business

Title

First Name

HIRENKUMAR

Middle

Last Name

ITALIA

Business Name

HIRENKUMAR D ITALIA MD

Original Issue Date

07/01/2011

Effective Date

07/01/2011

Expiration Date

06/30/2012

City

BELLEVILLE

State

Zip

62220

County

SAINT CLAIR

Specialty/Qualifier

Sports Medicine (Family Practice)

Ever Disciplined

LastModifiedDate

06/17/2011