STEPHANIE M DALLA RIVA MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036161104

License Status

ACTIVE

Business

Title

First Name

STEPHANIE

Middle

Last Name

DALLA RIVA

Business Name

STEPHANIE M DALLA RIVA MD

Original Issue Date

06/30/2022

Effective Date

07/22/2023

Expiration Date

07/31/2026

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Ever Disciplined

LastModifiedDate

07/22/2023