TITO A CHAMPENA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****52

License Status

NOT RENEWED

Business

First Name

TITO A

Last Name

CHAMPENA

Suffix

Business Name

TITO A CHAMPENA MD

Original Issue Date

08/11/2008

Effective Date

08/11/2008

Expiration Date

07/31/2011

City

PEORIA

State

Zip

61605

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020