BRAD L SUPRENANT DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****40

License Status

ACTIVE

Business

First Name

BRAD L

Last Name

SUPRENANT

Suffix

Business Name

BRAD L SUPRENANT DO

Original Issue Date

09/04/1985

Effective Date

05/13/2023

Expiration Date

07/31/2026

City

KANKAKEE

State

Zip

60901

County

KANKAKEE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/13/2023