GEOFFREY EDWARD MICKELLS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****15

License Status

NOT RENEWED

Business

Title

First Name

GEOFFREY

Middle

EDWARD

Last Name

MICKELLS

Business Name

GEOFFREY EDWARD MICKELLS MD

Original Issue Date

05/14/2012

Effective Date

07/21/2014

Expiration Date

07/31/2017

City

CHICAGO

State

Zip

60613

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017