DENISE M MAMMOLITO MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****52

License Status

ACTIVE

Business

First Name

DENISE M

Last Name

MAMMOLITO

Suffix

Business Name

DENISE M MAMMOLITO MD

Original Issue Date

04/18/1991

Effective Date

06/21/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61606

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/21/2023