LESTELLA DOROTHY BELL BIVENS MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125076765

License Status

CANCELLED

Business

Title

First Name

LESTELLA

Middle

DOROTHY BELL

Last Name

BIVENS

Business Name

LESTELLA DOROTHY BELL BIVENS MD

Original Issue Date

06/24/2020

Effective Date

06/24/2020

Expiration Date

06/23/2023

City

CHICAGO

State

Zip

60615

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

04/16/2020