JOSEPH ANTHONY KMIECIK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****16

License Status

NOT RENEWED

Business

First Name

JOSEPH

Middle

ANTHONY

Last Name

KMIECIK

Suffix

Business Name

JOSEPH ANTHONY KMIECIK MD

Original Issue Date

06/28/2011

Effective Date

06/28/2011

Expiration Date

07/31/2014

City

DEKALB

State

Zip

60115

County

DEKALB

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020