KATHLEEN MARY POWELL MATTIOLI MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****85

License Status

ACTIVE

Business

Title

First Name

KATHLEEN

Middle

MARY

Last Name

POWELL MATTIOLI

Business Name

KATHLEEN MARY POWELL MATTIOLI MD

Original Issue Date

02/08/2023

Effective Date

06/28/2023

Expiration Date

07/31/2026

City

LIBERTYVILLE

State

Zip

60048

County

LAKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/28/2023