STACEY NICOLE NICKOLOFF DO 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

STACEY

Middle

NICOLE

Last Name

NICKOLOFF

Suffix

Business Name

STACEY NICOLE NICKOLOFF DO

Original Issue Date

06/19/2003

Effective Date

07/17/2017

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60631

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021