TEQUILLA S STANCIEL MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****65

License Status

ACTIVE

Business

Title

First Name

TEQUILLA

Middle

Last Name

STANCIEL

Business Name

TEQUILLA S STANCIEL MD

Original Issue Date

02/01/2021

Effective Date

07/13/2023

Expiration Date

07/31/2026

City

EVANSTON

State

Zip

60201

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/13/2023