MARK DESTACHE MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036159952

License Status

ACTIVE

Business

Title

First Name

MARK

Last Name

DESTACHE

Business Name

MARK DESTACHE MD

Original Issue Date

03/25/2022

Effective Date

05/30/2023

Expiration Date

07/31/2026

City

SAINT PAUL

State

Zip

55105

Ever Disciplined

LastModifiedDate

05/30/2023