GUSTAVO MALTE VON DER LANCKEN MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****10

License Status

ACTIVE

Business

First Name

GUSTAVO

Middle

MALTE

Last Name

VON DER LANCKEN

Suffix

Business Name

GUSTAVO MALTE VON DER LANCKEN MD

Original Issue Date

07/14/2003

Effective Date

06/05/2023

Expiration Date

07/31/2026

City

GRANITE CITY

State

Zip

62040

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/05/2023