ALISA THERESE THAVIKULWAT MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125069602

License Status

EXPIRED

Business

Title

First Name

ALISA

Middle

THERESE

Last Name

THAVIKULWAT

Business Name

ALISA THERESE THAVIKULWAT MD

Original Issue Date

07/01/2016

Effective Date

07/01/2016

Expiration Date

06/30/2019

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Ophthalmology

Ever Disciplined

LastModifiedDate

10/02/2019