GLEN LEE RICCA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****34

License Status

NOT RENEWED

Business

First Name

GLEN

Middle

LEE

Last Name

RICCA

Suffix

Business Name

GLEN LEE RICCA MD

Original Issue Date

01/01/1997

Effective Date

06/19/2017

Expiration Date

09/30/2020

City

STREATOR

State

Zip

61364

County

LA SALLE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021