KENNETH MICHAEL BRANTLEY 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

Title

First Name

KENNETH

Middle

MICHAEL

Last Name

BRANTLEY

Business Name

KENNETH MICHAEL BRANTLEY MD

Original Issue Date

08/31/2015

Effective Date

08/31/2015

Expiration Date

07/31/2017

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017