MARIAM PESTVENIDZE MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125083823

License Status

ACTIVE

Business

Title

First Name

MARIAM

Last Name

PESTVENIDZE

Business Name

MARIAM PESTVENIDZE MD

Original Issue Date

06/24/2024

Effective Date

06/24/2024

Expiration Date

06/23/2027

City

EVANSTON

State

Zip

60202

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

05/20/2024