MICHAEL ANTHONY ACQUAVIVA MD - Medical Doctor License in Illinois | # 125049997

MICHAEL ANTHONY ACQUAVIVA MD

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125049997

License Status

CANCELLED

Business

N

First Name

MICHAEL

Middle

ANTHONY

Last Name

ACQUAVIVA

Suffix

MD

Business Name

MICHAEL ANTHONY ACQUAVIVA MD

Original Issue Date

06/24/2005

Effective Date

06/24/2005

Expiration Date

06/30/2008

State

IL

Specialty/Qualifier

Anesthesiology

Ever Disciplined

N

LastModifiedDate

09/22/2006