JACK PETER KOTLARZ MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****36

License Status

ACTIVE

Business

Title

First Name

JACK

Middle

PETER

Last Name

KOTLARZ

Business Name

JACK PETER KOTLARZ MD

Original Issue Date

05/22/2024

Effective Date

05/22/2024

Expiration Date

07/31/2026

City

ROCKFORD

State

Zip

61104

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/22/2024