MICHAEL J MARTIN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****43

License Status

NOT RENEWED

Business

Title

First Name

MICHAEL

Middle

Last Name

MARTIN

Business Name

MICHAEL J MARTIN MD

Original Issue Date

12/13/2004

Effective Date

12/13/2004

Expiration Date

07/31/2008

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020