HEENA ADITYA BIRBAL JAIN MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125061715

License Status

CANCELLED

Business

Title

First Name

HEENA

Middle

ADITYA

Last Name

BIRBAL JAIN

Business Name

HEENA ADITYA BIRBAL JAIN MD

Original Issue Date

07/01/2012

Effective Date

07/01/2012

Expiration Date

06/30/2015

City

CHAMPAIGN

State

Zip

61822

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

03/24/2014