VITALI G MIRONOV MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125039612

License Status

EXPIRED

Business

First Name

VITALI

Middle

Last Name

MIRONOV

Suffix

Business Name

VITALI G MIRONOV MD

Original Issue Date

07/01/1999

Effective Date

07/01/1999

Expiration Date

06/30/2002

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006