JONATHAN BAUTISTA TANAWAN MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125078767

License Status

CANCELLED

Business

Title

First Name

JONATHAN

Middle

BAUTISTA

Last Name

TANAWAN

Business Name

JONATHAN BAUTISTA TANAWAN MD

Original Issue Date

07/01/2021

Effective Date

07/01/2021

Expiration Date

06/30/2024

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

05/20/2021