MIGUEL ENRIQUE MANRIQUE PALAVICCINI MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125081021

License Status

CANCELLED

Business

Title

First Name

MIGUEL

Middle

ENRIQUE

Last Name

MANRIQUE PALAVICCINI

Business Name

MIGUEL ENRIQUE MANRIQUE PALAVICCINI MD

Original Issue Date

07/01/2022

Effective Date

07/01/2022

Expiration Date

06/30/2025

City

CHICAGO

State

Zip

60657

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

05/01/2025