DANIEL JON OSTLIE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****26

License Status

NOT RENEWED

Business

Title

First Name

DANIEL

Middle

JON

Last Name

OSTLIE

Business Name

DANIEL JON OSTLIE MD

Original Issue Date

01/30/2013

Effective Date

07/07/2014

Expiration Date

07/31/2017

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

11/01/2017