SUSAN KAY MANTELL MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125044947

License Status

EXPIRED

Business

First Name

SUSAN

Middle

KAY

Last Name

MANTELL

Suffix

Business Name

SUSAN KAY MANTELL MD

Original Issue Date

07/01/2002

Effective Date

07/01/2002

Expiration Date

06/30/2005

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006