BROOKE IVAN POLK MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****64

License Status

ACTIVE

Business

Title

First Name

BROOKE

Middle

IVAN

Last Name

POLK

Business Name

BROOKE IVAN POLK MD

Original Issue Date

05/16/2018

Effective Date

04/28/2023

Expiration Date

07/31/2026

City

SHILOH

State

Zip

62269

County

SAINT CLAIR

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/28/2023