MICHAEL T ECKSTROM Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****64

License Status

CANCELLED

Business

First Name

MICHAEL T

Last Name

ECKSTROM

Business Name

MICHAEL T ECKSTROM

Original Issue Date

07/25/1995

Effective Date

07/25/1995

Expiration Date

07/31/2002

City

EAST ST LOUIS

State

Zip

62201

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006