KAVITHA SUSAN JACOB MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036146566

License Status

ACTIVE

Business

Title

First Name

KAVITHA

Middle

SUSAN

Last Name

JACOB

Business Name

KAVITHA SUSAN JACOB MD

Original Issue Date

06/25/2018

Effective Date

07/18/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61637

County

PEORIA

Ever Disciplined

LastModifiedDate

07/18/2023