DOMINIC LOUIS RICCIARDI MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****88

License Status

NOT RENEWED

Business

First Name

DOMINIC

Middle

LOUIS

Last Name

RICCIARDI

Suffix

Business Name

DOMINIC LOUIS RICCIARDI MD

Original Issue Date

08/09/2004

Effective Date

08/09/2004

Expiration Date

07/31/2008

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

11/06/2008