MAMAK EATESAM MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125060479

License Status

CANCELLED

Business

Title

First Name

MAMAK

Last Name

EATESAM

Business Name

MAMAK EATESAM MD

Original Issue Date

09/26/2011

Effective Date

09/26/2011

Expiration Date

09/25/2014

City

CHICAGO

State

Zip

60657

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

06/22/2012