KEITH W BRUNINGA MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****80

License Status

ACTIVE

Business

First Name

KEITH W

Last Name

BRUNINGA

Suffix

Business Name

KEITH W BRUNINGA MD

Original Issue Date

11/30/1992

Effective Date

04/07/2023

Expiration Date

07/31/2026

City

HINES

State

Zip

60141

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2023