KRISTI AMANDA BOGAN 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

KRISTI

Middle

AMANDA

Last Name

BOGAN

Business Name

KRISTI AMANDA BOGAN MD

Original Issue Date

09/04/2018

Effective Date

09/04/2018

Expiration Date

09/30/2020

City

ROCKFORD

State

Zip

61103

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021