BRIAN DEBELEN VICUNA Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****81

License Status

NOT RENEWED

Business

First Name

BRIAN

Middle

DEBELEN

Last Name

VICUNA

Business Name

BRIAN DEBELEN VICUNA

Original Issue Date

10/12/2004

Effective Date

04/24/2007

Expiration Date

07/31/2008

City

CHICAGO

State

Zip

60611

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2008