JAKE RYAN PORTILLO MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125080756

License Status

EXPIRED

Business

Title

First Name

JAKE

Middle

RYAN

Last Name

PORTILLO

Business Name

JAKE RYAN PORTILLO MD

Original Issue Date

07/01/2022

Effective Date

07/01/2022

Expiration Date

06/30/2025

City

WHEATON

State

Zip

60187

County

DUPAGE

Specialty/Qualifier

Physical Medicine and Rehabilitation

Ever Disciplined

LastModifiedDate

11/03/2025