MIRIAM JILL WHITE SULLIVAN Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036063951

License Status

NOT RENEWED

Business

First Name

MIRIAM JILL

Middle

WHITE

Last Name

SULLIVAN

Business Name

MIRIAM JILL WHITE SULLIVAN

Original Issue Date

02/25/1982

Effective Date

06/07/2017

Expiration Date

09/30/2020

City

SPRINGFIELD

State

Zip

62769

County

SANGAMON

Ever Disciplined

LastModifiedDate

01/14/2021