LAWRENCE LOUIS CICCARELLI MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036087282

License Status

NOT RENEWED

Business

Title

First Name

LAWRENCE

Middle

LOUIS

Last Name

CICCARELLI

Business Name

LAWRENCE LOUIS CICCARELLI MD

Original Issue Date

08/24/1993

Effective Date

08/24/1993

Expiration Date

07/31/2005

City

MOUNT VERNON

State

Zip

62864

County

JEFFERSON

Ever Disciplined

LastModifiedDate

09/20/2006

Case Number

1999001931

Action

Revocation

Discipline Start Date

04/12/2006

Discipline Reason

Violated the conditions of his probation.