NATHANIEL KYLE BALLEK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****93

License Status

NOT RENEWED

Business

Title

First Name

NATHANIEL

Middle

KYLE

Last Name

BALLEK

Business Name

NATHANIEL KYLE BALLEK MD

Original Issue Date

01/25/2012

Effective Date

01/25/2012

Expiration Date

07/31/2014

City

SPRINGFIELD

State

Zip

62707

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014