NICHOLAS J BEVILACQUA DPM Podiatrist License verification

Business Entity

NOT RENEWED

License Type

Podiatrist

Description

LICENSED PODIATRY CONTROLLED SUBSTANCE

License Number

31*****17

License Status

NOT RENEWED

Business

First Name

NICHOLAS

Middle

Last Name

BEVILACQUA

Suffix

DPM

Business Name

NICHOLAS J BEVILACQUA DPM

Original Issue Date

07/27/2006

Effective Date

11/21/2006

Expiration Date

01/31/2009

City

NORTH CHICAGO

State

Zip

60064

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/17/2009