JEFFREY H KIVIAT MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****44

License Status

NOT RENEWED

Business

Title

First Name

JEFFREY

Middle

Last Name

KIVIAT

Business Name

JEFFREY H KIVIAT MD

Original Issue Date

02/09/1984

Effective Date

04/17/2008

Expiration Date

07/31/2011

City

ALTON

State

Zip

62002

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011