SUSAN R PROVOW MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036077142

License Status

INACTIVE

Business

First Name

SUSAN R

Last Name

PROVOW

Suffix

Business Name

SUSAN R PROVOW MD

Original Issue Date

06/14/1988

Effective Date

06/05/2014

Expiration Date

07/31/2017

City

ROCK FALLS

State

Zip

61071

County

WHITESIDE

Ever Disciplined

LastModifiedDate

04/12/2017