BENNETT SETH WALSTATTER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****15

License Status

NOT RENEWED

Business

First Name

BENNETT

Middle

SETH

Last Name

WALSTATTER

Suffix

Business Name

BENNETT SETH WALSTATTER MD

Original Issue Date

01/24/2011

Effective Date

04/11/2017

Expiration Date

09/30/2020

City

GRAND RAPIDS

State

Zip

49525

County

MICHIGAN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021