THOMAS A MIKKELSON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****38

License Status

NOT RENEWED

Business

First Name

THOMAS

Middle

Last Name

MIKKELSON

Suffix

Business Name

THOMAS A MIKKELSON MD

Original Issue Date

01/06/1999

Effective Date

06/26/2017

Expiration Date

09/30/2020

City

CENTREVILLE

State

Zip

62207

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021