BRANDON BLAKE CONINE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****05

License Status

NOT RENEWED

Business

Title

First Name

BRANDON

Middle

BLAKE

Last Name

CONINE

Business Name

BRANDON BLAKE CONINE MD

Original Issue Date

08/27/2015

Effective Date

05/30/2017

Expiration Date

09/30/2020

City

KANKAKEE

State

Zip

60901

County

KANKAKEE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021