DIANE M W BONTKE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****41

License Status

NOT RENEWED

Business

First Name

DIANE

Middle

M W

Last Name

BONTKE

Suffix

Business Name

DIANE M W BONTKE MD

Original Issue Date

09/27/2001

Effective Date

08/07/2014

Expiration Date

07/31/2017

City

SPRINGFIELD

State

Zip

62703

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020