BENJAMIN BENTLEY FAITELSON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****19

License Status

NOT RENEWED

Business

First Name

BENJAMIN

Middle

BENTLEY

Last Name

FAITELSON

Suffix

Business Name

BENJAMIN BENTLEY FAITELSON MD

Original Issue Date

08/04/1998

Effective Date

08/04/1998

Expiration Date

07/31/2002

City

VANDALIA

State

Zip

62471

County

FAYETTE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006