MICHAEL THOMAS AMBROSE MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125057111

License Status

CANCELLED

Business

First Name

MICHAEL

Middle

THOMAS

Last Name

AMBROSE

Suffix

Business Name

MICHAEL THOMAS AMBROSE MD

Original Issue Date

06/26/2010

Effective Date

06/26/2010

Expiration Date

06/25/2012

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

06/10/2010