MICHAEL ANTHONY ACQUAVIVA MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****35

License Status

CANCELLED

Business

First Name

MICHAEL

Middle

ANTHONY

Last Name

ACQUAVIVA

Suffix

Business Name

MICHAEL ANTHONY ACQUAVIVA MD

Original Issue Date

08/07/2007

Effective Date

04/17/2008

Expiration Date

07/31/2011

City

MAYWOOD

State

Zip

60153

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2011