LARS KEKOA VAN ETTEN MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****18

License Status

ACTIVE

Business

Title

First Name

LARS

Middle

KEKOA

Last Name

VAN ETTEN

Business Name

LARS KEKOA VAN ETTEN MD

Original Issue Date

02/23/2023

Effective Date

08/10/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/10/2023