IAN VANANTWERP DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125078762

License Status

ACTIVE

Business

Title

First Name

IAN

Last Name

VANANTWERP

Business Name

IAN VANANTWERP DO

Original Issue Date

06/26/2024

Effective Date

06/26/2024

Expiration Date

06/25/2026

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Diagnostic Radiology

Ever Disciplined

LastModifiedDate

03/22/2024