PHILLIP LEE MICKELSEN 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

Title

First Name

PHILLIP

Middle

LEE

Last Name

MICKELSEN

Business Name

PHILLIP LEE MICKELSEN MD

Original Issue Date

12/01/2009

Effective Date

12/01/2009

Expiration Date

07/31/2011

City

WOODSTOCK

State

Zip

60098

County

MCHENRY

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011