JONATHAN BAUTISTA TANAWAN MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****89

License Status

ACTIVE

Business

Title

First Name

JONATHAN

Middle

BAUTISTA

Last Name

TANAWAN

Business Name

JONATHAN BAUTISTA TANAWAN MD

Original Issue Date

06/12/2024

Effective Date

06/12/2024

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/24/2026