DANIEL P VICENCIO MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****50

License Status

ACTIVE

Business

First Name

DANIEL P

Last Name

VICENCIO

Suffix

Business Name

DANIEL P VICENCIO MD

Original Issue Date

01/10/1995

Effective Date

06/12/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60660

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/12/2023