MICHAEL DEAN MACK DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****54

License Status

ACTIVE

Business

First Name

MICHAEL

Middle

DEAN

Last Name

MACK

Suffix

Business Name

MICHAEL DEAN MACK DO

Original Issue Date

03/09/2016

Effective Date

04/06/2023

Expiration Date

07/31/2026

City

ROCK ISLAND

State

Zip

61201

County

ROCK ISLAND

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/06/2023