License holder summary

DENNIS MICHAEL DEROSA is a Controlled Substance Registration - Physician licensed to practice in Indiana. The address on file for DENNIS MICHAEL DEROSA is 5734 CONVENTRY LANE, FORT WAYNE IN 46804. This licensed professional license is current. The license was granted 10/31/1986 and expired on 10/31/2015.

Indiana

Professional Licensing Agency

DENNIS MICHAEL DEROSA
Controlled Substance Registration - Physician
License number
01029440B
Date granted
10/31/1986
Date expires
10/31/2015
Class
Controlled Substance Registration - Physician
Status
Active
Address
5734 CONVENTRY LANE, FORT WAYNE IN 46804
indianalicensing.org
ID 5853231
LAST UPDATED 2024-03-23 01:25:35 UTC

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