RANDY K SULAVER MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125061943

License Status

CANCELLED

Business

Title

First Name

RANDY

Middle

Last Name

SULAVER

Business Name

RANDY K SULAVER MD

Original Issue Date

06/26/2015

Effective Date

06/26/2015

Expiration Date

06/25/2017

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Urology

Ever Disciplined

LastModifiedDate

01/09/2015