ENRIQUE VIA-REQUE Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****12

License Status

NOT RENEWED

Business

First Name

ENRIQUE

Last Name

VIA-REQUE

Business Name

ENRIQUE VIA-REQUE

Original Issue Date

01/01/1997

Effective Date

05/14/2014

Expiration Date

07/31/2017

City

WINFIELD

State

Zip

60190

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017