SANDRA J MICCI Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****40

License Status

ACTIVE

Business

First Name

SANDRA J

Last Name

MICCI

Business Name

SANDRA J MICCI

Original Issue Date

03/12/2001

Effective Date

01/15/2026

Expiration Date

03/01/2028

City

CHICAGO

State

Zip

60612

County

COOK

Delegated Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

01/15/2026