ALAN J LICUP MD

Business Entity
NOT RENEWED

Medical Doctor

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

33*****09

NOT RENEWED

N

ALAN

J

LICUP

MD

ALAN J LICUP MD

06/10/2011

10/01/2020

07/31/2023

PLEASANT PRAIRIE

WI

53158

WISCONSIN

PRACTITIONER

II III IV V

N

11/30/2023