KEITH FREDERICK MUCCINO 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

First Name

KEITH

Middle

FREDERICK

Last Name

MUCCINO

Suffix

Business Name

KEITH FREDERICK MUCCINO MD

Original Issue Date

01/06/2005

Effective Date

07/20/2017

Expiration Date

09/30/2020

City

MAYWOOD

State

Zip

60153

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021