EDWARD BASTA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****41

License Status

NOT RENEWED

Business

First Name

EDWARD

Last Name

BASTA

Suffix

Business Name

EDWARD BASTA MD

Original Issue Date

01/06/1982

Effective Date

01/06/1982

Expiration Date

07/31/1990

City

CHICAGO

State

Zip

60639

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006