W MARK IWANICKI MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****08

License Status

ACTIVE

Business

First Name

W MARK

Last Name

IWANICKI

Suffix

Business Name

W MARK IWANICKI MD

Original Issue Date

01/01/1997

Effective Date

07/28/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60630

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/28/2023