MICHAEL ANTHONY ACQUAVIVA MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125049997

License Status

CANCELLED

Business

First Name

MICHAEL

Middle

ANTHONY

Last Name

ACQUAVIVA

Suffix

Business Name

MICHAEL ANTHONY ACQUAVIVA MD

Original Issue Date

06/24/2005

Effective Date

06/24/2005

Expiration Date

06/30/2008

City

MAYWOOD

State

Zip

60153

County

COOK

Specialty/Qualifier

Anesthesiology

Ever Disciplined

LastModifiedDate

09/22/2006