Indiana
Professional Licensing Agency
Michael Kooistra, Jr
Controlled Substance Registration - Physician
License number
01045333B
Date granted
07/01/1996
Date expires
10/31/2015
Class
Controlled Substance Registration - Physician
Status
Active
Address
6950 Daisy Street, Auburn IN 46706
indianalicensing.org
ID 5819413
LAST UPDATED 2024-03-29 22:37:04 UTC
LAST UPDATED 2024-03-29 22:37:04 UTC
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