Indiana
Professional Licensing Agency
Lee Michael Periolat
Controlled Substance Registration - Physician
License number
01026484B
Date granted
08/31/1986
Date expires
10/31/2015
Class
Controlled Substance Registration - Physician
Status
Active
Address
601 Wall Street, Valparaiso IN 46383
indianalicensing.org
ID 5929063
LAST UPDATED 2024-02-26 13:01:52 UTC
LAST UPDATED 2024-02-26 13:01:52 UTC
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