AMANDO A RENIVA Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125040476

License Status

EXPIRED

Business

First Name

AMANDO

Middle

Last Name

RENIVA

Business Name

AMANDO A RENIVA

Original Issue Date

08/20/1999

Effective Date

08/20/1999

Expiration Date

08/19/2002

City

CHICAGO

State

Zip

60649

County

COOK

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006