MARK AWANTANG MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****12

License Status

NOT RENEWED

Business

Title

First Name

MARK

Last Name

AWANTANG

Business Name

MARK AWANTANG MD

Original Issue Date

01/16/2019

Effective Date

01/16/2019

Expiration Date

09/30/2020

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021