SUSAN K KINAST-PORTER MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****68

License Status

CANCELLED

Business

Title

First Name

SUSAN

Middle

Last Name

KINAST-PORTER

Business Name

SUSAN K KINAST-PORTER MD

Original Issue Date

09/08/2008

Effective Date

09/08/2008

Expiration Date

07/31/2011

City

FREEPORT

State

Zip

61032

County

STEPHENSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2011