LEILANI BONGAO PATHAK MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125080981

License Status

EXPIRED

Business

Title

First Name

LEILANI

Middle

BONGAO

Last Name

PATHAK

Business Name

LEILANI BONGAO PATHAK MD

Original Issue Date

07/01/2022

Effective Date

07/01/2022

Expiration Date

06/30/2024

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Endocrinology-Diabetes-Metabolism

Ever Disciplined

LastModifiedDate

10/30/2024