LEE A BALAKLAW MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****30

License Status

NOT RENEWED

Business

First Name

LEE A

Last Name

BALAKLAW

Suffix

Business Name

LEE A BALAKLAW MD

Original Issue Date

04/19/1993

Effective Date

04/19/1993

Expiration Date

07/31/1993

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2011