THADDEUS J MANCZKO 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

First Name

THADDEUS

Middle

Last Name

MANCZKO

Suffix

Business Name

THADDEUS J MANCZKO MD

Original Issue Date

03/08/2001

Effective Date

07/18/2014

Expiration Date

07/31/2017

City

WILLOW SPRINGS

State

Zip

60480

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017