AMY KATHLEEN LICIS MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****27

License Status

ACTIVE

Business

Title

First Name

AMY

Middle

KATHLEEN

Last Name

LICIS

Business Name

AMY KATHLEEN LICIS MD

Original Issue Date

06/04/2021

Effective Date

07/22/2023

Expiration Date

07/31/2026

City

SAINT LOUIS

State

Zip

63110

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/22/2023