ANGELA MILLER BENNETT MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****72

License Status

NOT RENEWED

Business

First Name

ANGELA

Middle

MILLER

Last Name

BENNETT

Suffix

Business Name

ANGELA MILLER BENNETT MD

Original Issue Date

12/17/2002

Effective Date

12/17/2002

Expiration Date

07/31/2005

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006