CAMIA P ACEVEDO-CUSTODIO MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****13

License Status

NOT RENEWED

Business

First Name

CAMIA P

Last Name

ACEVEDO-CUSTODIO

Suffix

Business Name

CAMIA P ACEVEDO-CUSTODIO MD

Original Issue Date

11/17/1987

Effective Date

11/17/1987

Expiration Date

07/31/1996

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

04/12/2017