GLEN EDWIN D SOUZA MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125085013

License Status

ACTIVE

Business

Title

First Name

GLEN

Middle

EDWIN

Last Name

D SOUZA

Business Name

GLEN EDWIN D SOUZA MD

Original Issue Date

08/01/2024

Effective Date

08/01/2024

Expiration Date

07/31/2025

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Advanced Rhinology Fellowship

Ever Disciplined

LastModifiedDate

07/05/2024