DANIEL L ICENOGLE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****64

License Status

NOT RENEWED

Business

First Name

DANIEL

Middle

Last Name

ICENOGLE

Suffix

Business Name

DANIEL L ICENOGLE MD

Original Issue Date

08/01/1984

Effective Date

08/01/1984

Expiration Date

07/31/1987

City

JOHNSBURG

State

Zip

60050

County

MCHENRY

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006