MARK E IDSTROM (Credential# 1276265) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is August 1, 2016. The license expiration date date is July 31, 2017. The license status is INACTIVE.
MARK E IDSTROM is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.054134. The credential type is physician/surgeon. The effective date is August 1, 2016. The expiration date is July 31, 2017. The business address is 1007 Westover Rd, Kansas City, MO 64113-1123. The current status is inactive.
| Licensee Name | MARK E IDSTROM |
| Credential ID | 1276265 |
| Credential Number | 1.054134 |
| Credential Type | Physician/Surgeon |
| Business Address |
1007 Westover Rd Kansas City MO 64113-1123 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE - LAPSED DUE TO NON-RENEWAL |
| Issue Date | 2015-05-12 |
| Effective Date | 2016-08-01 |
| Expiration Date | 2017-07-31 |
| Refresh Date | 2017-11-03 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1285047 | CSP.0060244 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2015-06-01 | 2015-06-01 - 2017-02-28 | INACTIVE |
| Street Address | 1007 WESTOVER RD |
| City | KANSAS CITY |
| State | MO |
| Zip Code | 64113-1123 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| James M Hogan | 1034 West 67th Street, Kansas City, MO 64113 | Professional Engineer | 2019-02-01 ~ 2020-01-31 |
| Thomas M Brooks | 12 W Dartmouth Rd, Kansas City, MO 64113 | Professional Engineer | 2020-02-01 ~ 2021-01-31 |
| Fiona M Madden | 424 W 62 Terr, Kansas City, MO 64113 | Youth Camp Director | 2019-06-17 ~ |
| Benoit Blondeau | 414 W 68 Ter, Kansas City, MO 64113 | Physician/surgeon | ~ |
| Jean-michel Oquet | 1208 W69th Terrace, Kansas City, MO 64113 | Resident Physician | 2018-07-01 ~ 2021-06-30 |
| Donald G Boysen · Crown Cntr Rdvlpmnt Corp | 201 E 68th Terr, Kansas City, MO 64113 | Professional Engineer | 1990-12-18 ~ 1992-01-31 |
| Jon Niemuth | 22 East 55 Terrace, Kansas City, MO 64113 | Architect | 2006-09-01 ~ 2007-07-31 |
| Lorie A Montag | 1015 West 69th Terr, Kansas City, MO 64113 | Physician/surgeon | ~ 1998-04-30 |
| Kathleen A Conway | 824 Huntington Rd, Kansas City, MO 64113-1344 | Registered Nurse | 2018-11-01 ~ 2019-10-31 |
| Tammara S Cutter | 424 W 69th St, Kansas City, MO 64113-1935 | Registered Nurse | 2019-11-01 ~ 2020-10-31 |
| Find all Licenses in zip 64113 | |||
| City | KANSAS CITY |
| Zip Code | 64113 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + KANSAS CITY |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Mark M Silverstein | Mark Silverstein,md, Manchester, NJ 08759 | Physician/surgeon | 2020-02-01 ~ 2021-01-31 |
| Mark Davis | Po Box 222, Abingdon, MD 21009-0222 | Physician/surgeon | ~ |
| Mark J Harary Md | 31 River Rd Ste 100, Cos Cob, CT 06807-2152 | Physician/surgeon | 2012-06-01 ~ 2013-05-31 |
| Mark N Lobato | Ms # 11-tub, Hartford, CT 06134 | Physician/surgeon | 2015-12-01 ~ 2016-11-30 |
| Mark L Fox | 145 Huguenot St Ste 610, New Rochelle, NY 10801-5200 | Physician/surgeon | 2017-12-01 ~ 2018-11-30 |
| Ron Mark | 6 Annette Way, Jericho, NY 11753 | Physician/surgeon | 2019-09-01 ~ 2020-08-31 |
| Mark Levin | 6 Gel Ct, Monsey, NY 10952-1956 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Mark Snyder | 120 Terrace Ln, Hannibal, MO 63401-2768 | Physician/surgeon | ~ |
| Mark Dam | 15 Barringer Rd, Darien, CT 06820-2012 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Mark L Friedman | Po Box 298, Newbury, NH 03255-0298 | Physician/surgeon | 2020-03-01 ~ 2021-02-28 |
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| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).