KEITH D MOSIENKO MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****81

License Status

NOT RENEWED

Business

First Name

KEITH D

Last Name

MOSIENKO

Suffix

Business Name

KEITH D MOSIENKO MD

Original Issue Date

12/17/1991

Effective Date

12/17/1991

Expiration Date

07/31/1996

City

ALTON

State

Zip

62002

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006