MITCHELL LAINE LEWIS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****69

License Status

NOT RENEWED

Business

Title

First Name

MITCHELL

Middle

LAINE

Last Name

LEWIS

Business Name

MITCHELL LAINE LEWIS MD

Original Issue Date

11/06/2013

Effective Date

11/06/2013

Expiration Date

07/31/2014

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

04/12/2017