BONAFACIO M RIVERA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036052549

License Status

NOT RENEWED

Business

First Name

BONAFACIO M

Last Name

RIVERA

Suffix

Business Name

BONAFACIO M RIVERA MD

Original Issue Date

03/26/1976

Effective Date

03/26/1976

Expiration Date

07/31/2005

City

NORTHBROOK

State

Zip

60062

County

COOK

Ever Disciplined

LastModifiedDate

03/24/2007

Case Number

2001004059

Action

Suspension

Discipline Start Date

05/14/2003

Discipline Reason

Failed to file and pay Illinois income taxes.