License holder summary

Kevin Rolph Ericson is a Controlled Substance Registration - Physician licensed to practice in Indiana. The address on file for Kevin Rolph Ericson is 611 E. Douglas Rd. Suite 407, Mishawaka IN 46545. This licensed professional license is current. The license was granted 04/24/1997 and expired on 10/31/2015.

Indiana

Professional Licensing Agency

Kevin Rolph Ericson
Controlled Substance Registration - Physician
License number
01046492B
Date granted
04/24/1997
Date expires
10/31/2015
Class
Controlled Substance Registration - Physician
Status
Active
Address
611 E. Douglas Rd. Suite 407, Mishawaka IN 46545
indianalicensing.org
ID 5895381
LAST UPDATED 2024-02-28 13:49:18 UTC

This website is unaffiliated with the Professional Licensing Agency. Please verify all information directly with the relevant official government authority.

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