ANTONIO B BAUTISTA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****63

License Status

NOT RENEWED

Business

First Name

ANTONIO B

Last Name

BAUTISTA

Suffix

Business Name

ANTONIO B BAUTISTA MD

Original Issue Date

01/01/1997

Expiration Date

07/31/2008

City

CHICAGO

State

Zip

60623

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2008