ALAN J LICUP MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125051652

License Status

CANCELLED

Business

First Name

ALAN

Middle

Last Name

LICUP

Suffix

Business Name

ALAN J LICUP MD

Original Issue Date

06/25/2009

Effective Date

06/25/2009

Expiration Date

06/24/2011

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Specialty/Qualifier

General Surgery

Ever Disciplined

LastModifiedDate

05/04/2009