AMANDO A RENIVA Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****86

License Status

ACTIVE

Business

First Name

AMANDO

Middle

Last Name

RENIVA

Business Name

AMANDO A RENIVA

Original Issue Date

08/13/2002

Effective Date

07/24/2023

Expiration Date

07/31/2026

City

OAK PARK

State

Zip

60302

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/24/2023