TEDDI ISHAK BACHAWATY MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****00

License Status

NOT RENEWED

Business

First Name

TEDDI

Middle

ISHAK

Last Name

BACHAWATY

Suffix

Business Name

TEDDI ISHAK BACHAWATY MD

Original Issue Date

02/24/2005

Effective Date

07/12/2011

Expiration Date

07/31/2014

City

LOVES PARK

State

Zip

61111

County

WINNEBAGO

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

04/12/2017