W L GREGORY SIEFERT MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****46

License Status

CANCELLED

Business

Title

First Name

W L

Middle

GREGORY

Last Name

SIEFERT

Business Name

W L GREGORY SIEFERT MD

Original Issue Date

05/27/2004

Effective Date

05/27/2004

Expiration Date

07/31/2005

City

LIBERTYVILLE

State

Zip

60048

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2011