GENESIS T MANCHA MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125077066

License Status

CANCELLED

Business

Title

First Name

GENESIS

Middle

Last Name

MANCHA

Business Name

GENESIS T MANCHA MD

Original Issue Date

07/01/2020

Effective Date

07/01/2020

Expiration Date

06/30/2023

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

04/27/2020