KIM MATTHEW TREVIRANUS MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****59

License Status

ACTIVE

Business

First Name

KIM MATTHEW

Last Name

TREVIRANUS

Suffix

Business Name

KIM MATTHEW TREVIRANUS MD

Original Issue Date

01/01/1997

Effective Date

04/25/2023

Expiration Date

07/31/2026

City

DIXON

State

Zip

61021

County

LEE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/25/2023