RYAN BERNARD MITACEK MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****38

License Status

ACTIVE

Business

Title

First Name

RYAN

Middle

BERNARD

Last Name

MITACEK

Business Name

RYAN BERNARD MITACEK MD

Original Issue Date

01/20/2022

Effective Date

04/08/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60607

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

04/08/2023