STACY M RAVIV Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****41

License Status

ACTIVE

Business

First Name

STACY

Middle

Last Name

RAVIV

Business Name

STACY M RAVIV

Original Issue Date

08/01/2005

Effective Date

04/07/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60614

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2023