BENJAMIN S BALTASAR MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****88

License Status

NOT RENEWED

Business

First Name

BENJAMIN S

Last Name

BALTASAR

Suffix

Business Name

BENJAMIN S BALTASAR MD

Original Issue Date

01/01/1997

Effective Date

05/04/2011

Expiration Date

07/31/2014

City

EAST DUNDEE

State

Zip

60118

County

KANE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/11/2017