THEODORE L VANDERVELDE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036105170

License Status

NOT RENEWED

Business

First Name

THEODORE

Middle

Last Name

VANDERVELDE

Suffix

Business Name

THEODORE L VANDERVELDE MD

Original Issue Date

07/11/2001

Effective Date

08/02/2017

Expiration Date

09/30/2020

City

ALTON

State

Zip

62002

County

MADISON

Ever Disciplined

LastModifiedDate

01/14/2021