BENJAMIN AUGUSTIN NESSEIM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****47

License Status

NOT RENEWED

Business

First Name

BENJAMIN

Middle

AUGUSTIN

Last Name

NESSEIM

Suffix

Business Name

BENJAMIN AUGUSTIN NESSEIM MD

Original Issue Date

05/14/2007

Effective Date

05/14/2007

Expiration Date

07/31/2008

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2008