RYAN ANDREW MACKE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****03

License Status

NOT RENEWED

Business

Title

First Name

RYAN

Middle

ANDREW

Last Name

MACKE

Business Name

RYAN ANDREW MACKE MD

Original Issue Date

02/27/2014

Effective Date

06/18/2014

Expiration Date

07/31/2017

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017