MEGAN HICKMAN STREET MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****65

License Status

NOT RENEWED

Business

First Name

MEGAN

Middle

HICKMAN

Last Name

STREET

Suffix

Business Name

MEGAN HICKMAN STREET MD

Original Issue Date

07/01/2010

Effective Date

07/01/2010

Expiration Date

07/31/2011

City

MARYVILLE

State

Zip

62026

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/15/2013