RICHARD LARK DICICCO MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****58

License Status

CANCELLED

Business

First Name

RICHARD

Middle

LARK

Last Name

DICICCO

Suffix

Business Name

RICHARD LARK DICICCO MD

Original Issue Date

08/17/2004

Effective Date

08/17/2004

Expiration Date

07/31/2005

City

DOWNERS GROVE

State

Zip

60515

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006