KENNETH CRAIG MICETICH MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****33

License Status

ACTIVE

Business

First Name

KENNETH

Middle

CRAIG

Last Name

MICETICH

Suffix

Business Name

KENNETH CRAIG MICETICH MD

Original Issue Date

01/01/1997

Effective Date

06/07/2023

Expiration Date

07/31/2026

City

BURR RIDGE

State

Zip

60527

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/07/2023