RICHARD D BASILE JR MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125028714

License Status

EXPIRED

Business

First Name

RICHARD D

Last Name

BASILE JR

Suffix

Business Name

RICHARD D BASILE JR MD

Original Issue Date

06/11/1992

Effective Date

06/11/1992

Expiration Date

06/30/1995

City

PARK RIDGE

State

Zip

60068

County

INDIANA

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006