KEATTIYOAT WATTANAKIT MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****61

License Status

ACTIVE

Business

Title

First Name

KEATTIYOAT

Last Name

WATTANAKIT

Business Name

KEATTIYOAT WATTANAKIT MD

Original Issue Date

07/01/2010

Effective Date

07/06/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61614

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/06/2023