ANDREW PAUL THALIATH MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125073740

License Status

CANCELLED

Business

Title

First Name

ANDREW

Middle

PAUL

Last Name

THALIATH

Business Name

ANDREW PAUL THALIATH MD

Original Issue Date

06/26/2022

Effective Date

06/26/2022

Expiration Date

06/25/2023

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Neurology

Ever Disciplined

LastModifiedDate

03/03/2022