KALLISTA FANOULA KAMBEROS DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125079010

License Status

CANCELLED

Business

Title

First Name

KALLISTA

Middle

FANOULA

Last Name

KAMBEROS

Business Name

KALLISTA FANOULA KAMBEROS DO

Original Issue Date

06/28/2021

Effective Date

06/28/2021

Expiration Date

06/27/2024

City

OTTAWA

State

Zip

61350

County

LA SALLE

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

04/29/2021