GRANT W SU MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036117645

License Status

ACTIVE

Business

First Name

GRANT

Middle

Last Name

Suffix

Business Name

GRANT W SU MD

Original Issue Date

02/16/2007

Effective Date

04/06/2023

Expiration Date

07/31/2026

City

SPRINGFIELD

State

Zip

62703

County

SANGAMON

Ever Disciplined

LastModifiedDate

04/06/2023