MANLY MICHAELSON Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****64

License Status

NOT RENEWED

Business

First Name

MANLY

Last Name

MICHAELSON

Business Name

MANLY MICHAELSON

Original Issue Date

07/24/1990

Effective Date

07/24/1990

Expiration Date

07/31/1993

City

COAL VALLEY

State

Zip

61240

County

ROCK ISLAND

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006