IRENA VIVIAN VITKOVITSKY MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****46

License Status

NOT RENEWED

Business

Title

First Name

IRENA

Middle

VIVIAN

Last Name

VITKOVITSKY

Business Name

IRENA VIVIAN VITKOVITSKY MD

Original Issue Date

04/11/2012

Effective Date

07/27/2017

Expiration Date

09/30/2020

City

BELLEVILLE

State

Zip

62226

County

SAINT CLAIR

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021