DANIEL P VICENCIO MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****51

License Status

NOT RENEWED

Business

First Name

DANIEL P

Last Name

VICENCIO

Suffix

Business Name

DANIEL P VICENCIO MD

Original Issue Date

12/12/1996

Effective Date

07/22/2008

Expiration Date

07/31/2011

City

CHICAGO

State

Zip

60609

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020