Physician Misconduct and Physician Discipline

Physician Information

Physician Information

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Physician Records

 Physician Last Name:


 Physician First Name:


 Physician Middle Name:


 Address:Address redacted
 License Number:188026
 License Type:MD
 Year of Birth: 1954
 Effective Date:01/16/2018
 Action Description for DOH Webpage:License surrender.
 Misconduct Description for DOH Webpage:The physician did not contest the charge of having committed professional misconduct by having been convicted in the Wisconsin Circuit Court Branch 3, Portage County, State of Wisconsin of Conspiracy to Commit Resisting or Obstructing an Officer ; Operating Under the Influence of an Intoxicant or Other Drug ; Felony Bail Jumping ; Obtaining a Prescription Drug with Fraud; Intimidation of a Witness and Operating a Vehicle While Revoked. Previously on October 23, 2017 the physician's New York State medical license was summarily suspended by the New York State Commissioner of Health.
  License Restrictions for DOH Webpage:
 Board Order:
CHRG 188026.pdf
BRD 188026.pdf