MARK DESTACHE MD - Medical Doctor License in Minnesota | # 33*****42

MARK DESTACHE MD

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****42

License Status

ACTIVE

Business

N

Title

MD

First Name

MARK

Last Name

DESTACHE

Business Name

MARK DESTACHE MD

Original Issue Date

04/06/2022

Effective Date

05/30/2023

Expiration Date

07/31/2026

State

MN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

N

LastModifiedDate

05/30/2023