PHILIP BLANCO ANTIPORTA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****40

License Status

NOT RENEWED

Business

Title

First Name

PHILIP

Middle

BLANCO

Last Name

ANTIPORTA

Business Name

PHILIP BLANCO ANTIPORTA MD

Original Issue Date

09/08/2014

Effective Date

06/28/2017

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60649

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021