DONALD STEVEN PROVENZANO Podiatrist License verification

Business Entity

NOT RENEWED

License Type

Podiatrist

Description

LICENSED PODIATRY CONTROLLED SUBSTANCE

License Number

31*****14

License Status

NOT RENEWED

Business

First Name

DONALD STEVEN

Last Name

PROVENZANO

Business Name

DONALD STEVEN PROVENZANO

Original Issue Date

01/01/1998

Expiration Date

09/01/1982

City

BLOOMINGDALE

State

Zip

60108

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/25/2006