KYLA M BENNETT MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****04

License Status

ACTIVE

Business

Title

First Name

KYLA

Middle

Last Name

BENNETT

Business Name

KYLA M BENNETT MD

Original Issue Date

03/02/2017

Effective Date

05/24/2023

Expiration Date

07/31/2026

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/24/2023