TIMOTHY RAYMOND NIEDZIELAK DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****15

License Status

ACTIVE

Business

Title

First Name

TIMOTHY

Middle

RAYMOND

Last Name

NIEDZIELAK

Business Name

TIMOTHY RAYMOND NIEDZIELAK DO

Original Issue Date

09/25/2023

Effective Date

09/25/2023

Expiration Date

07/31/2026

City

BELVIDERE

State

Zip

61008

County

BOONE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/25/2023