CHRISTIAN WIRAWAN DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125079572

License Status

CANCELLED

Business

Title

First Name

CHRISTIAN

Last Name

WIRAWAN

Business Name

CHRISTIAN WIRAWAN DO

Original Issue Date

07/01/2023

Effective Date

07/01/2023

Expiration Date

06/30/2025

City

CHICAGO

State

Zip

60608

Specialty/Qualifier

Physical Medicine and Rehabilitation

Ever Disciplined

LastModifiedDate

06/21/2023