ANGELICA REVIS DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125077744

License Status

CANCELLED

Business

Title

First Name

ANGELICA

Last Name

REVIS

Business Name

ANGELICA REVIS DO

Original Issue Date

06/25/2021

Effective Date

06/25/2021

Expiration Date

06/24/2024

City

PARK RIDGE

State

Zip

60068

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

05/04/2021