MANUEL VALDIVIESO MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036045401

License Status

NOT RENEWED

Business

First Name

MANUEL

Last Name

VALDIVIESO

Suffix

Business Name

MANUEL VALDIVIESO MD

Original Issue Date

02/04/1972

Effective Date

05/13/2014

Expiration Date

07/31/2017

City

BINGHAM FARMS

State

Zip

48025

County

MICHIGAN

Ever Disciplined

LastModifiedDate

11/01/2017