MICHAEL THOMAS STACK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****53

License Status

NOT RENEWED

Business

Title

First Name

MICHAEL

Middle

THOMAS

Last Name

STACK

Business Name

MICHAEL THOMAS STACK MD

Original Issue Date

08/23/2021

Effective Date

08/23/2021

Expiration Date

07/31/2023

City

MATTOON

State

Zip

61938

County

COLES

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023