GHANSHYAM R PATEL MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125079599

License Status

CANCELLED

Business

Title

First Name

GHANSHYAM

Middle

Last Name

PATEL

Business Name

GHANSHYAM R PATEL MD

Original Issue Date

06/13/2022

Effective Date

06/13/2022

Expiration Date

06/12/2025

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

04/21/2022