TRAVIS MARK AMENGUAL Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125072037

License Status

CANCELLED

Business

First Name

TRAVIS

Middle

MARK

Last Name

AMENGUAL

Business Name

TRAVIS MARK AMENGUAL

Original Issue Date

06/23/2018

Effective Date

06/23/2018

Expiration Date

06/22/2021

City

CHICAGO

State

Zip

60657

County

COOK

Specialty/Qualifier

Psychiatry

Ever Disciplined

LastModifiedDate

04/11/2018