POOJA SRINIVAS DEWILDE DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125060705

License Status

CANCELLED

Business

Title

First Name

POOJA

Middle

SRINIVAS

Last Name

DEWILDE

Business Name

POOJA SRINIVAS DEWILDE DO

Original Issue Date

08/21/2011

Effective Date

08/21/2011

Expiration Date

08/20/2014

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

08/12/2011