KENNETH P JUSTESEN DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****17

License Status

ACTIVE

Business

First Name

KENNETH P

Last Name

JUSTESEN

Suffix

Business Name

KENNETH P JUSTESEN DO

Original Issue Date

05/11/1995

Effective Date

07/07/2023

Expiration Date

07/31/2026

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/07/2023