MARGO AIDAN GROMOLL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036125958

License Status

NOT RENEWED

Business

Title

First Name

MARGO

Middle

AIDAN

Last Name

GROMOLL

Business Name

MARGO AIDAN GROMOLL MD

Original Issue Date

06/08/2010

Effective Date

05/23/2011

Expiration Date

07/31/2014

City

PEORIA

State

Zip

61603

County

PEORIA

Ever Disciplined

LastModifiedDate

11/17/2014