BRYAN ANOCHILI IKEUDENTA MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125078130

License Status

CANCELLED

Business

Title

First Name

BRYAN

Middle

ANOCHILI

Last Name

IKEUDENTA

Business Name

BRYAN ANOCHILI IKEUDENTA MD

Original Issue Date

07/01/2021

Effective Date

07/01/2021

Expiration Date

06/30/2024

City

LOVES PARK

State

Zip

61111

County

WINNEBAGO

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

04/20/2021