MICHAEL LEROY BRUIN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****79

License Status

NOT RENEWED

Business

First Name

MICHAEL

Middle

LEROY

Last Name

BRUIN

Suffix

Business Name

MICHAEL LEROY BRUIN MD

Original Issue Date

05/23/2020

Effective Date

05/23/2020

Expiration Date

07/31/2023

City

EFFINGHAM

State

Zip

62401

County

EFFINGHAM

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023