MARK J PIDALA Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

LIMITED MEDICAL TEMPORARY PERMIT

License Number

130000170

License Status

EXPIRED

Business

First Name

MARK

Middle

Last Name

PIDALA

Business Name

MARK J PIDALA

Original Issue Date

06/12/1992

Effective Date

06/12/1992

Expiration Date

09/30/1992

City

URISANA

State

Zip

61801

County

CHAMPAIGN

Specialty/Qualifier

Colon & Rectal Surgery

Ever Disciplined

LastModifiedDate

09/25/2006