EDILIA M VIVANCO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****60

License Status

NOT RENEWED

Business

First Name

EDILIA M

Last Name

VIVANCO

Business Name

EDILIA M VIVANCO

Original Issue Date

11/25/1992

Effective Date

11/25/1992

Expiration Date

07/31/1996

City

CHICAGO

State

Zip

60657

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006