NICHOLAS MARCEL DE LA RUA MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125075168

License Status

CANCELLED

Business

Title

First Name

NICHOLAS

Middle

MARCEL

Last Name

DE LA RUA

Business Name

NICHOLAS MARCEL DE LA RUA MD

Original Issue Date

07/01/2019

Effective Date

07/01/2019

Expiration Date

06/30/2022

City

CHICAGO

State

Zip

60612

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

06/22/2019