ELLEN M MIDDENDORF Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****02

License Status

ACTIVE

Business

First Name

ELLEN

Middle

Last Name

MIDDENDORF

Business Name

ELLEN M MIDDENDORF

Original Issue Date

07/22/2003

Effective Date

04/06/2023

Expiration Date

07/31/2026

City

WATERLOO

State

Zip

62298

County

MONROE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/15/2025