MICHELLE SUSANNE FAULL DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125057832

License Status

EXPIRED

Business

Title

First Name

MICHELLE

Middle

SUSANNE

Last Name

FAULL

Business Name

MICHELLE SUSANNE FAULL DO

Original Issue Date

07/01/2010

Effective Date

07/01/2010

Expiration Date

06/30/2011

City

NORMAL

State

Zip

61761

County

MCLEAN

Specialty/Qualifier

Rotating Internship

Ever Disciplined

LastModifiedDate

07/19/2011