ENRIQUE VIA-REQUE Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036055450

License Status

NOT RENEWED

Business

First Name

ENRIQUE

Last Name

VIA-REQUE

Business Name

ENRIQUE VIA-REQUE

Original Issue Date

08/11/1977

Effective Date

05/14/2014

Expiration Date

07/31/2017

City

WINFIELD

State

Zip

60190

County

DUPAGE

Ever Disciplined

LastModifiedDate

11/01/2017