SUSAN GRACE BOLTON MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036082604

License Status

ACTIVE

Business

First Name

SUSAN GRACE

Last Name

BOLTON

Suffix

Business Name

SUSAN GRACE BOLTON MD

Original Issue Date

06/13/1991

Effective Date

04/21/2023

Expiration Date

07/31/2026

City

CHAMPAIGN

State

Zip

61822

County

CHAMPAIGN

Ever Disciplined

LastModifiedDate

04/21/2023