SUSAN KIM REYNOLDS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****95

License Status

NOT RENEWED

Business

Title

First Name

SUSAN

Middle

KIM

Last Name

REYNOLDS

Business Name

SUSAN KIM REYNOLDS MD

Original Issue Date

08/30/2017

Effective Date

08/30/2017

Expiration Date

09/30/2020

City

BETHALTO

State

Zip

62010

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021