GREGORY RICHARD MICKLOW MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****85

License Status

NOT RENEWED

Business

First Name

GREGORY

Middle

RICHARD

Last Name

MICKLOW

Suffix

Business Name

GREGORY RICHARD MICKLOW MD

Original Issue Date

06/01/1999

Effective Date

06/01/1999

Expiration Date

07/31/2008

City

AURORA

State

Zip

60504

County

DUPAGE

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

11/06/2008