KANOKPORN MONGKOLRATTANOTHAI - Medical Doctor License in Illinois | # 33*****74

KANOKPORN MONGKOLRATTANOTHAI

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****74

License Status

NOT RENEWED

Business

N

First Name

KANOKPORN

Last Name

MONGKOLRATTANOTHAI

Business Name

KANOKPORN MONGKOLRATTANOTHAI

Original Issue Date

03/30/2005

Effective Date

05/11/2011

Expiration Date

07/31/2014

City

PEORIA

State

IL

Zip

61637

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

N

LastModifiedDate

11/17/2014