HRISSANTHI IKONOMIDOU MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****06

License Status

ACTIVE

Business

Title

First Name

HRISSANTHI

Last Name

IKONOMIDOU

Business Name

HRISSANTHI IKONOMIDOU MD

Original Issue Date

09/25/2018

Effective Date

06/06/2023

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

06/06/2023