KURT A MELSTROM JR Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****92

License Status

NOT RENEWED

Business

First Name

KURT

Middle

Last Name

MELSTROM JR

Business Name

KURT A MELSTROM JR

Original Issue Date

09/15/2005

Effective Date

04/17/2008

Expiration Date

07/31/2011

City

MAYWOOD

State

Zip

60153

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011