AMALIE CATHERINE THAVIKULWAT MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125071334

License Status

EXPIRED

Business

Title

First Name

AMALIE

Middle

CATHERINE

Last Name

THAVIKULWAT

Business Name

AMALIE CATHERINE THAVIKULWAT MD

Original Issue Date

06/25/2017

Effective Date

06/25/2017

Expiration Date

06/24/2018

City

CHICAGO

State

Zip

60657

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

10/25/2018