E RICHARD ENSRUD MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036032342

License Status

NOT RENEWED

Business

First Name

E RICHARD

Last Name

ENSRUD

Suffix

Business Name

E RICHARD ENSRUD MD

Original Issue Date

09/08/1953

Effective Date

05/05/2011

Expiration Date

07/31/2014

City

CHAMPAIGN

State

Zip

61821

County

CHAMPAIGN

Ever Disciplined

LastModifiedDate

11/17/2014