KAVITHA SUSAN JACOB MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125067450

License Status

CANCELLED

Business

Title

First Name

KAVITHA

Middle

SUSAN

Last Name

JACOB

Business Name

KAVITHA SUSAN JACOB MD

Original Issue Date

07/01/2015

Effective Date

07/01/2015

Expiration Date

06/30/2018

City

PEORIA

State

Zip

61605

County

PEORIA

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

06/08/2015