ANN M GROOTEGOED DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125037164

License Status

CANCELLED

Business

First Name

ANN

Middle

Last Name

GROOTEGOED

Suffix

Business Name

ANN M GROOTEGOED DO

Original Issue Date

07/25/1997

Effective Date

07/25/1997

Expiration Date

07/23/2000

City

PEORIA

State

Zip

61603

County

PEORIA

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006