NICHOLAS JACOB PRABHAKAR DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125080657

License Status

CANCELLED

Business

Title

First Name

NICHOLAS

Middle

JACOB

Last Name

PRABHAKAR

Business Name

NICHOLAS JACOB PRABHAKAR DO

Original Issue Date

06/25/2022

Effective Date

06/25/2022

Expiration Date

06/24/2025

City

PARK RIDGE

State

Zip

60068

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

06/01/2022