ANDREW STEPHEN BOUTSICARIS MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125077394

License Status

CANCELLED

Business

Title

First Name

ANDREW

Middle

STEPHEN

Last Name

BOUTSICARIS

Business Name

ANDREW STEPHEN BOUTSICARIS MD

Original Issue Date

06/22/2021

Effective Date

06/22/2021

Expiration Date

06/21/2024

City

MAYWOOD

State

Zip

60153

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

04/07/2021