DONALD E BANICKI MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036044380

License Status

INACTIVE

Business

Title

First Name

DONALD

Middle

Last Name

BANICKI

Business Name

DONALD E BANICKI MD

Original Issue Date

07/01/1971

Effective Date

08/01/2011

Expiration Date

07/31/2014

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

06/21/2014