KEVIN DIETRICH MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****92

License Status

ACTIVE

Business

Title

First Name

KEVIN

Last Name

DIETRICH

Business Name

KEVIN DIETRICH MD

Original Issue Date

04/29/2022

Effective Date

07/13/2023

Expiration Date

07/31/2026

City

BLOOMINGTON

State

Zip

61704

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/13/2023