KENNETH W BIRGE JR MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****72

License Status

ACTIVE

Business

First Name

KENNETH W

Last Name

BIRGE JR

Suffix

Business Name

KENNETH W BIRGE JR MD

Original Issue Date

03/04/1993

Effective Date

04/27/2023

Expiration Date

07/31/2026

City

BLOOMINGTON

State

Zip

61701

County

MCLEAN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/27/2023