ONNA G KONICEK DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****19

License Status

CANCELLED

Business

Title

First Name

ONNA

Middle

Last Name

KONICEK

Business Name

ONNA G KONICEK DO

Original Issue Date

07/14/2011

Effective Date

07/14/2011

Expiration Date

07/31/2014

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/08/2014