KEITH ANTHONY BONACQUISTI 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

First Name

KEITH

Middle

ANTHONY

Last Name

BONACQUISTI

Business Name

KEITH ANTHONY BONACQUISTI

Original Issue Date

05/18/2011

Effective Date

06/14/2017

Expiration Date

09/30/2020

City

ALTON

State

Zip

62002

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021